<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417713
Report Date: 12/08/2021
Date Signed: 12/08/2021 02:02:50 PM

Document Has Been Signed on 12/08/2021 02:02 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:GEVORKYAN FAMILY CHILD CAREFACILITY NUMBER:
197417713
ADMINISTRATOR:GEVORKYAN, TERESAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 744-7230
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
12/08/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:12 AM
MET WITH:Teresa Gevorkyan/LicenseeTIME COMPLETED:
02:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 12/08/2021 at 11:00 AM, Licensing program analyst (LPA) Miriam Silva Garibyan arrived at Gevorkyan Family Child Care Home 197417713 to conduct a Plan of Correction inspection for the following deficiencies cited during inspection conducted on 11/10/2021 by LPA Shandra Powell:
1) 1597.622(a)(1): (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
2) 102417(g)(10): The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (10) A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Sections 1596.846(b) and (c)
3) 102370(d): All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:
4) 102425(c): An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.
5) 102417(g)(9)(A): The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.
SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE: DATE: 12/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/08/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GEVORKYAN FAMILY CHILD CARE
FACILITY NUMBER: 197417713
VISIT DATE: 12/08/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
6) 102425(j)(2): The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:
7) 1596.8662(b)(1): On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
8) 1597.622(c): The family day care home shall maintain documentation of the required immunization or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

LPA Garibyan met with Teresa Gevorkyan, Licensee, who provided the tour of the facility to observe the corrections for deficiencies noted above. Licensee was present with six children ( including three infants).
1) LPA Garibyan obtained a written declaration from licensee declining the influenza vaccination. LPA also observed licensee's proof of immunization to pertussis and measles.
2) LPA Garibyan obtained a written declaration acknowledging understanding of a baby walker shall not be allowed on the premises of a family child care home. Licensee removed the baby walker on 11/10/2021.
3) LPA Garibyan obtained a written declaration acknowledging understanding of all individuals subject to a criminal record review prior to working, residing or volunteering in a licensed facility. Licensee released the assistant from her duties on 11/10/2021 until the assistant receives a criminal record clearance and association to the facility.
4) The Individual Infant Sleeping Plan is not required for the infants enrolled in the facility. Licensee has no infants up to 12 months enrolled in the facility.
5) LPA obtained a copy of the LOG for Fire/Disaster
6) LPA obtained a copy of the sleep logs for the infants enrolled
7) Licensee complete Mandated Reporter Training and provided a copy
SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GEVORKYAN FAMILY CHILD CARE
FACILITY NUMBER: 197417713
VISIT DATE: 12/08/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
8) LPA Garibyan obtained a written declaration from licensee declining the influenza vaccination. LPA also observed licensee's proof of immunization to pertussis and measles.
LPA Garibyan toured the facility with the licensee and observed four children present in the facility.
During POC visit on 12/08/21. LPA observed that Licensee has a current roster for 6 children enrolled. LPA reviewed six children’s files and observed files were complete. LPA observed the Acknowledgement of Receipt of licensing Reports LIC9224 with parents signatures.

At the time of the Plan Of Correction visit the facility was found to be in substantial compliance. LPA observed the Notice of site visit and Facility Evaluation Report ( LIC809 and LIC809-D) posted on the parent board.

Exit interview was conducted, no deficiencies were cited during today’s visit. A copy of the report and POC letter was provided to Licensee.
SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3