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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493615
Report Date: 12/10/2024
Date Signed: 12/10/2024 01:04:12 PM

Document Has Been Signed on 12/10/2024 01:04 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:ASATRYAN FAMILY CHILD CAREFACILITY NUMBER:
197493615
ADMINISTRATOR/
DIRECTOR:		ASATRYAN, ARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 938-0815
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
12/10/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:25 AM
MET WITH:Licensee, Ara AsatryanTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
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Licensing Program Analyst (LPA) Roberto Luque Avila conducted an unannounced annual inspection to the above facility on 12/10/2024. LPA arrived at the facility at 9:25AM, identified self and met with Lena Asatryan, facility representative who guided analyst on a tour of the facility. LPA provided facility representative with a copy of the LIC126 Entrance Checklist to help facilitate the inspection. LPA observed 10 children 3 staff upon arrival. At approximately 9:40 the Licensee arrived to the facility and completed the inspection. Per Licensee, operation hours are 7AM to 10PM. There are 12 children that are currently enrolled. The licensee is observed to be operating within the license capacity limitations. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted.

This is a one story home which consists of 3 bedrooms, 3 bathrooms, kitchen, dining room, living room, family room, front yard and fenced backyard. The children use the bathroom #3 located in bedroom #3. The restroom that children use was observed to be safe and sanitary. LPA observed that there is a screened fireplace in the living room. Per Licensee, areas off limits to children: Bedroom 1 and 2, Bathroom 1 and 2, kitchen, living room dining room, these areas are made inaccessible by locked doors and raised door knobs. The licensee provides food for children in care.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The facility has remodeled the rear two rooms that were off limits in order to make it into one room that is currently being used for childcare. There modifications were notified to the department on 5/29/24. However, an updated facility was not provided indicating that the room was going to be used for childcare. There is telephone service via cellphone that is used and the cellphone stays at the facility during operation hours. There is ventilation and heating via central air. Safe toys, play equipment and materials were observed.
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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Roberto Luque Avila
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2024
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: ASATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 197493615
VISIT DATE: 12/10/2024
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The licensee 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. Detergents, cleaning compounds, and medications, were observed to be inaccessible to children.

Licensee states that there currently is a firearm in the home. The firearm is being stored in a locked storage safe that is inaccessible to children. LPA observed the firearms chamber to be clear of ammunition. However, the firearm is currently being stored in the same box as the ammunition and 2 loaded magazine cartridges.

The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 9/10/2024, as indicated on service tag. Smoke and carbon monoxide detectors are located family room and were tested and are operable.

All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. Currently there is no documentation indicating a fire drill was done within the last 6 months.

Licensee states that they are not currently caring for infants. 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 discussed the safe sleep regulations with licensee [or facility representative] 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 [or facility representative] 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 any children left in parked vehicles. Car seats shall only be used for transportation. LPA did not observe any children sleeping in car seats. Page 2 of 4
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Roberto Luque Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024
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: ASATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 197493615
VISIT DATE: 12/10/2024
NARRATIVE
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The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 10/25/2025. There are first aid supplies available. LPA observed that the Licensee and assistants have proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file. The licensee does have proof of immunization against influenza, pertussis, and measles, However Staff #3 does not have record of Measles immunization on file.

Children’s records were reviewed, including emergency information and were observed to be complete.

LPA did not observe any pools, spas, hot tubs, fish ponds, or similar bodies of water during the inspection. There are no pets on the premises. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

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/

LPA advised that if a child shows signs of illness he/she/they shall be separated from other children. When a child is ill they are separated in the family room and parents are contacted to pick up their child.

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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process Page 3 of 4
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Roberto Luque Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024
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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: ASATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 197493615
VISIT DATE: 12/10/2024
NARRATIVE
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LPA advised the Applicant to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

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.

The following deficiencies listed on the attached deficiency page are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee/Director was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit.

A notice of site visit was given and must remain posted for 30 days.

During the exit interview, the licensee, confirmed that there are no Registered Sex Offenders living in the facility.

Exit interview conducted, appeal rights and report were provided with the licensee Ara Asatryan.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Roberto Luque Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024
LIC809 (FAS) - (06/04)
Page: 4 of 7
Document Has Been Signed on 12/10/2024 01:04 PM - It Cannot Be Edited


Created By: Roberto Luque Avila On 12/10/2024 at 12:12 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: ASATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 197493615

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)(C)
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: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. (C) Ammunition shall be stored and locked separately from firearms.

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. The Licensee currently has a firearm and ammunition stored in the same locked safe which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/11/2024
Plan of Correction
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Per licensee they will remove the fire arm from the home by the POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Roberto Luque Avila
LICENSING EVALUATOR SIGNATURE:
DATE: 12/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/10/2024


LIC809 (FAS) - (06/04)
Page: 5 of 7
Document Has Been Signed on 12/10/2024 01:04 PM - It Cannot Be Edited


Created By: Roberto Luque Avila On 12/10/2024 at 12:12 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: ASATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 197493615

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)1
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: (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. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child 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. There is no documentation indicating the disaster and fire drills have been completed within 6 months which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/10/2025
Plan of Correction
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Per licensee they will submit documentation of fire drill have been done by the POC due date.

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:Roberto Luque Avila
LICENSING EVALUATOR SIGNATURE:
DATE: 12/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/10/2024


LIC809 (FAS) - (06/04)
Page: 6 of 7
Document Has Been Signed on 12/10/2024 01:04 PM - It Cannot Be Edited


Created By: Roberto Luque Avila On 12/10/2024 at 12:12 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: ASATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 197493615

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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. There is no record of measles immunization on file for S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/10/2025
Plan of Correction
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Licensee will provide measles immunization record for S3 by the POC due date.
Type B
Section Cited
CCR
102416.3(a)(6)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.

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. The department has not currently recieved an updated facility sketch noting the change of off limits areas that were done in the home which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/10/2025
Plan of Correction
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Licensee will provide an updated facility sketch to include the updated off limits areas by the POC due date.
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:Roberto Luque Avila
LICENSING EVALUATOR SIGNATURE:
DATE: 12/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/10/2024


LIC809 (FAS) - (06/04)
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