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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700537
Report Date: 05/21/2025
Date Signed: 05/21/2025 10:22:10 AM

Document Has Been Signed on 05/21/2025 10:22 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:DOVLATYAN FAMILY CHILD CAREFACILITY NUMBER:
195700537
ADMINISTRATOR/
DIRECTOR:		KRISTINE DOVLATYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(747) 998-7577
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
05/21/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Kristine Dovlatyan, ApplicantTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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On 05/21/2025, beginning at 08:30 AM, Licensing Program Analyst (LPA) Elicia Calvillo conducted an announced Pre-Licensing inspection at 10015 Whitaker Avenue, North Hills, CA 91344. Applicant is applying for a Small Family Child Care Home, anticipating caring for 8 children from ages zero years to 14 years of age. The Applicants current proposed hours of operation are Monday through Sunday 07:00 AM – 10:00 PM. LPA met with Kristine Dovlatyan, Applicant, who guided LPA on a tour of the inside and outside of the home. Also present at arrival was an adult resident.

The applicant provided proof of control of property.

As drawn on the facility sketch and observed during the tour, this is a one-story residence consisting of a living room, dining room, kitchen, 3 bedrooms, 2 bathrooms, and attached garage. There is a front yard (no fence) used for dropping off and picking up children. There is a fenced outdoor play area in the back of the house.

The front yard will be used for children to enter and exit the facility.

LPA observed the following inside areas will be used for child care: living room, dining room, and bathroom #2 will be used for child care activities.

The living room and dining room will be used for play activities, learning activities, sleeping, and eating. LPA observed 8 chairs, 2 tables. Applicant stated the will purchase eight (8) mats/cots/beds. Bathroom #1 located in the hallway near bedroom #2 and bedroom #3 will be used by children. The vanity cabinet holds personal care products and is made inaccessible with the use of child proof latch. LPA observed that the bathroom that children will use was safe and sanitary.

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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Elicia Calvillo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DOVLATYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700537
VISIT DATE: 05/21/2025
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Applicant stated that when a child shows signs of an illness the child will isolated in living room or dining room away from other children.

The kitchen will be used to prepare snacks and meals. Applicants stated they will provide snacks and meals and understands if food is brought in by the parent the container will be labeled with the child’s name. Applicant stated they will also offer snacks and meals from an outside third-party vendor. LPA observed that kitchen area is made inaccessible with the use of door lock and child proof latches.

There is telephone service via a cellphone that must remain in the facility during the hours of operation.

The areas inaccessible to parents and children include combination kitchen, bedroom #1, bedroom #2, bedroom #3, and bathroom #2 are made inaccessible with the use of door locks and child proof latches.

The bedrooms and hallway are equipped with combination smoke and carbon monoxide detectors, were tested and are operable. LPA did observe a combination carbon monoxide and smoke detector in hallway near bathroom #2. LPA advised that the smoke detectors and carbon monoxide detector should be checked periodically, and batteries should be replaced periodically.

There is a working fire extinguisher, the valve on the 2A:10BC fire extinguisher indicates fully charged and was serviced on 03/12/2025 and is located in the closet near bathroom #2.

LPA reviewed with Applicant that all homes shall conduct fire and disaster drill at least once every six months and document the date and time of each drill.

There is adequate central heating and ventilation for safety and comfort. LPA did not observe an open face heater. LPA observed a fireplace in the living room and Applicant stated that the fireplace is not working and is only used for decorative purposes.

The play yard can be accessed from the door in the kitchen and is secured with a door lock. The outdoor play area does have a shaded area from the building. The play yard ground is covered with cement, grass, gravel, and is fenced. LPA did not observe any objects that can pose a danger to children on the outdoor play yard. Applicant stated that they have outdoor play items in storage and will send LPA a picture of the items.

LPA did not observe any pools, spas, hot tubs, fish ponds, or similar bodies of water during the inspection.

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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Elicia Calvillo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DOVLATYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700537
VISIT DATE: 05/21/2025
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Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. The Applicant states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock.

Per Applicant, there are no firearms or other weapons on the premises. LPA did not observe any firearms or other weapons on the premises.

Per Applicant there are pets on the premises. LPA observed one (1) dog fish on the premises. During the hours of operation, the dog will be kept in a cage in the back yard.

LPA reviewed with Applicant that children eating may only be in highchairs and that car seats are utilized only for transportation. Applicant was made aware that children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children.

LPA reviewed with Applicant that regulation prohibits smoking in a private residence licensed as a family child care home. Per Applicant, no one in the facility smokes.

LPA reviewed with Applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

LPA reviewed with Applicant the reporting and notification requirements for any unusual incident or injury to the Child Care Regional Office by telephone within 24 hours and within 7 days complete a written report, LIC 624B Unusual Incident/Injury Report (copy provided to Applicant).

The Applicant has completed training on preventive health practices including Pediatric First Aid and CPR. The Applicant's Pediatric First Aid and CPR expires on 01/2026. There are first aid supplies available in the hallway closet. Applicant has proof of immunization against influenza, pertussis, and measles. The Applicant has proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate.

Criminal Record Clearance - Family Child Care Homes, Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance

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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Elicia Calvillo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025
LIC809 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DOVLATYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700537
VISIT DATE: 05/21/2025
NARRATIVE
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or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Applicants and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed Applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at http://www.cpsc.gov and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility.

LPA reviewed with Applicant that applicant shall be present in the home and shall ensure that children in care are supervised at all times.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Applicant was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

On this date, 01/14/2025, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Elicia Calvillo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025
LIC809 (FAS) - (06/04)
Page: 6 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DOVLATYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700537
VISIT DATE: 05/21/2025
NARRATIVE
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Before license approval the applicant will need to complete the following corrections by 06/21/2025

  • Purchase 8 mats/cots/beds
  • Take photo of outdoor play items that are in storage.

Exit interview was conducted with Kristine Dovlatyan, Applicant including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Elicia Calvillo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025
LIC809 (FAS) - (06/04)
Page: 3 of 6