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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418057
Report Date: 02/07/2023
Date Signed: 02/07/2023 04:26:21 PM

Document Has Been Signed on 02/07/2023 04:26 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:MKHITARYAN FAMILY CHILD CAREFACILITY NUMBER:
197418057
ADMINISTRATOR:MKHITARYAN, MARIYETTAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 893-9447
CITY:VALLEY VILLAGESTATE: CAZIP CODE:
91607
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 8DATE:
02/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:56 PM
MET WITH:MKHITARYAN, MARIYETTA- LicenseeTIME COMPLETED:
05:00 PM
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On 2/7/2023, Licensing Program Analyst (LPA), Suzette Ornelas conducted an unannounced Annual Required Inspection and was met by Licensee, MKHITARYAN, MARIYETTA. Also present during the inspection was licensees two assistants who are associated to the facility. LPA observed 8 children present. The home was toured with the licensee to conduct a health and safety inspection. Hours of operation are Monday through Friday, 8am to 6pm.

Facility sketch reviewed and all areas identified on the facility sketch were inspected. This is a one-story home which consists of 2 bedrooms, 2 bathrooms, kitchen/dining room, living room, children's play area room, front yard and backyard. The isolation area will be in the living room. The on-limit areas are as follows:children play area room, bathroom (located next to children's play area room), living room (for napping), hallway (when walking to and from the living room area and when leading the children to the front yard play area). The off-limit areas are as follows: bedroom 1, bathroom 2, kitchen/dining room, laundry room (only when leading children to the backyard play area/to child care rooms) and backyard (designated area).

The Fire Extinguishers (2A-10-BC) is mounted on the wall in the laundry room. There is a working smoke/carbon monoxide detector located in the. The required carbon monoxide detectors and smoke detectors are in operable condition as tested by the licensee.

The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. The First Aid kit was observed and complete. Per LIS the facility annual fees are current. The facility roster was observed, and current. There are age appropriate toys and napping equipment on the premises. Licensee has posted as required the License, and all other required postings in a visible location.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: MKHITARYAN FAMILY CHILD CARE
FACILITY NUMBER: 197418057
VISIT DATE: 02/07/2023
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There are no firearms or ammunition on the premises. There is no swimming pool or other bodies of water on the premises. Fireplace located in the living room is covered and made inaccessible to children in care.

Licensee does not care for infants. Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the front yard is fenced and there are no hazards to children present. LPA discussed the importance of ensuring that equipment is regularly inspected, dusted off as needed and removed if broken.

Capacity as specified on the license is being maintained. LPA reviewed 5 children's records and observed records were complete. An emergency fire/disaster drill has been completed in the last 6 months. LPA provided licensee with a copy of a sample Emergency Drill Log. Licensee and Assistants pediatric CPR/First Aid is current. Licensee and Assistants Mandated Reporter Training is not current. LPA provided information regarding the Mandated Reported Training regulation and the requirement to complete every two years (mandatedreporterca.com). Licensee will provide proof of completion to LPA via email. Licensee will provide proof of MMR/Tdap immunization's for licensee and assistant to LPA via email. 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.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023
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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: MKHITARYAN FAMILY CHILD CARE
FACILITY NUMBER: 197418057
VISIT DATE: 02/07/2023
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Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, 2 type B deficiencies are being cited.
Type B: 1596.8662(b)(1)
Type B: 1597.622(c)

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/07/2023 04:26 PM - It Cannot Be Edited


Created By: Suzette Ornelas On 02/07/2023 at 04:10 PM
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: MKHITARYAN FAMILY CHILD CARE
FACILITY NUMBER: 197418057

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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 licensee and assistant did not have proof of current mandated reporter training which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/21/2023
Plan of Correction
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Licensee will provide proof to LPA via email.
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations 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.

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 licensee and assistant did not have proof of MMR/Tdap which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/21/2023
Plan of Correction
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Licensee will provide proof to LPA via email.
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:Lisa Rios
LICENSING EVALUATOR NAME:Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2023


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