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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417713
Report Date: 03/13/2025
Date Signed: 03/13/2025 11:19:41 AM

Document Has Been Signed on 03/13/2025 11:19 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:GEVORKYAN FAMILY CHILD CAREFACILITY NUMBER:
197417713
ADMINISTRATOR/
DIRECTOR:		GEVORKYAN, TERESAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 744-7230
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
03/13/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Teresa Gevorkyan, LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On 03/13/2025, Licensing Program Analyst (LPA) Elicia Calvillo conducted an unannounced 3 Year Required Annual inspection at 16331 Shamhart Drive, Granada Hills, CA. 91344. LPA arrived at the facility at 08:30 AM, identified self and met with Teresa Gevorkyan, Licensee who guided analyst on a tour of the inside and outside of the facility. There were 6 children and 1 Assistant present. LPA provided Licensee with a copy of the LIC126 Entrance Checklist -Family Child Care Homes to help facilitate the inspection. Licensee cares for children from ages 3 months to 12-year-olds. Facility hours of operation are Monday to Friday from 07:00AM to 06:00PM.

The licensee provided proof of control of property.

The family child care home is a one story dwelling, includes combination living/dining room, kitchen, 4 bedrooms, 3 bathrooms, and attached garage. There is a front yard that is used for children to enter and exit the facility. There is a fenced outdoor play area in the back of the house.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The children use the combination living / dining room for child care activities, sleeping, and eating. There are tables and chairs, toys and play items that are safe, clean, and appropriate for the ages of the children. Bedroom #1 is used for infant napping, LPA observed there are cribs and bed linens available for children. The attached garage is used as an extra sleeping area and to store extra cribs, cots, and bed linens.

The children use the bathroom #1 located in the hallway near the kitchen. The vanity cabinet holds hand soap and paper products, and no hazards were observed. LPA observed that the bathroom that children use was safe and sanitary.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2025
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 6
Document Has Been Signed on 03/13/2025 11:19 AM - It Cannot Be Edited


Created By: Elicia Calvillo On 03/13/2025 at 10:05 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: GEVORKYAN FAMILY CHILD CARE
FACILITY NUMBER: 197417713

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/13/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that a trampoline which is not allowed in a family child care was observed in the outdoor play yard accessible to children which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/14/2025
Plan of Correction
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Licensee stated they will have the trampoline removed from the outdoor play yard and will email LPA a picture by the plan of correction due date 04/14/2025.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that Licensee and Staff #1 did not have a Mandated Reporter Completion Certificate readily available upon request which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/14/2025
Plan of Correction
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Licensee stated that the Licensee and staff #1 will completed the Mandated Reporter Training and provide LPA a copy of the Mandated Reporter Training Completion Certificate by the plan or correction due date 04/14/2025.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Rita Ramos
LICENSING EVALUATOR NAME:Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/13/2025


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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: GEVORKYAN FAMILY CHILD CARE
FACILITY NUMBER: 197417713
VISIT DATE: 03/13/2025
NARRATIVE
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Per Licensee, when a child shows signs of illness they will be separated from other children and isolated in bedroom #1.

The kitchen is made inaccessible with the use of child proof latches. The licensee provides food for children in care. Licensee stated when food is brought to the facility it is labeled with child’s name and stored properly.

There is telephone service via a cellphone. LPA informed Licensee’s that the cellphone must remain at the facility during the hours of operations.

The outdoor play area is located at the back yard of the house, is fenced and there are no hazards to children present. LPA observed appropriate toys, climbing structure, and other play equipment for children in care. The outdoor play yard is covered with cement and artificial grass to absorb falls. LPA observed adequate shade with a covered patio.

Per Licensee, areas off limits to children and parents include kitchen, 4 bedrooms, 2 bathroom and are made inaccessible by use of door locks.

LPA did observe a front yard, per Licensee, the front yard is not used for child care activities and is used for dropping off and picking up children.

Per Licensee, there are no firearms, ammunition, or poisons on the premises. LPA did not observe any firearms, ammunition, or poisons during the inspection. Poisons, detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children are stored where they are inaccessible to children.

Per Licensee, there are no pets on the premises. LPA did not observe any pets on the premises.

Per Licensee, there are no bodies of water. LPA did not observe any swimming pool, wading pools, hot tubs, spas, fish ponds, fountains or other similar bodies of water.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
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: GEVORKYAN FAMILY CHILD CARE
FACILITY NUMBER: 197417713
VISIT DATE: 03/13/2025
NARRATIVE
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LPA did observe a fireplace and has a glass screen to prevent access by children. LPA did not observe an open face heater during the inspection. There is a working fire extinguisher, the valve on the required 2A 10BC fire extinguisher indicates fully charged and Licensee confirmed last service date. There is a smoke detector in the combination living/dining room and was tested and operable. The carbon monoxide detector is located in the kitchen and was tested and operable.

There is currently one (1) infant enrolled with the facility. LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://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 and/or any other item that fall into these categories are not permitted in a family child care facility.
LPA did observe a Trampoline in the outdoor play area located in the backyard, which is not permitted in a family child care facility. Licensee stated that they will have the trampoline removed from the outdoor play area.

Licensee was reminded that children in care are to be supervised at all times and made aware that children shall not be left in parked vehicles. Car seats shall only be used for transportation purposes and shall not be used for sleeping.

Capacity as specified on the license is being maintained.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted.

LPA reviewed a sample of children’s files and observed files were complete and documented on the LIC857.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
LIC809 (FAS) - (06/04)
Page: 4 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: GEVORKYAN FAMILY CHILD CARE
FACILITY NUMBER: 197417713
VISIT DATE: 03/13/2025
NARRATIVE
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An emergency fire/disaster drill has been completed and documented within the last 6 months on 10/15/2024. Licensee Mandated Reporter Training was completed on 11/21/2021 and was expired. Licensee stated they will complete the Mandated Reporter Training and provide LPA with a copy of the completion certificate. Licensee’s pediatric CPR/First Aid expires on 05/2025.

LPA reviewed one (1) personal record and observed that the file was not complete and documented on the LIC 859. The personnel record was missing immunization record for proof of pertussis immunization and missing the mandated reporter training completion certificate.

LPA reviewed with licensee 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.

During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.
Licensee was reminded that all adults 18 and over living or working in the home, 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 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.

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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
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: GEVORKYAN FAMILY CHILD CARE
FACILITY NUMBER: 197417713
VISIT DATE: 03/13/2025
NARRATIVE
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Licensee 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.

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-care­ licensing/subscribe and select the Child Care option to receive email communication.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

During today's visit, per Title 22, Division 12, Chapter 3, of the California Code of Regulations, there are two (2 ) Type B citations being cited for sections 102417 (g) Operation of Family Child Care Home and 1596.8662(b)(1) Administration of a Child Day Care Licensing.

A Notice of Site Visit was given and must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to comply with posting requirement will result in an immediate civil penalty of $100.00.

Exit interview was conducted with Teresa Gevorkyan, Licensee including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
LIC809 (FAS) - (06/04)
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