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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495009
Report Date: 03/01/2022
Date Signed: 03/01/2022 09:29:50 AM

Document Has Been Signed on 03/01/2022 09:29 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:DAVTYAN FAMILY CHILD CAREFACILITY NUMBER:
197495009
ADMINISTRATOR:LUSIK DAVTYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 229-6434
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
03/01/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
07:00 AM
MET WITH:Lusik Davtyan/ApplicantTIME COMPLETED:
09:30 AM
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On 03/01/2022 at 07:00 AM Licensing Program Analyst (LPA) Silva Garibyan conducted an announced visit for the purpose of a Pre-licensing inspection with Lusik Davtyan, Applicant. Applicant was informed that we are going to tour the home for a pre-licensing requirement per title 22 regulations and health and safety standard code requirements. Applicant is applying for a large day-care of a capacity of 14. The applicant has installed the pull fire alarm that is required for large Family Child Care Homes and has an approved fire clearance ( approved on 02/25/2022 by inspector Michael Miller). Hours of operation for the facility will be 6:00 AM- 11:00 PM Monday- Friday and will be closed all major holidays. Ages served are new born - School age. There is a pool in the back yard. The fence surrounding the pool is less than 5 feet high. The kitchen and bedroom windows are giving direct access to the pool. Applicant has submitted a disaster plan. The applicant have completed preventive health and safety/Childhood Nutrition/ Lead Exposure Prevention and Mandated Reporter training ( completed on 12/17/21). The applicant has current pediatric CPR/First Aid training that will expire in January of 2024.

Interior: This is a single story dwelling with one bedroom, one bathroom, kitchen , living/dining room. This is the back house on the property. The front unit on the property has different address and occupied by the owners ( the address for the front unit: 7022 Murietta Ave, Van Nuys, CA 91405).The home was inspected inside and out for safety, comfort, cleanliness, telephone service (cell phone operating at all times), heating and ventilation, poisons, detergents/cleaning compounds, medication and hazardous items that can pose a danger to children are kept in latched cabinets inaccessible during operating hours.

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SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2022
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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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: DAVTYAN FAMILY CHILD CARE
FACILITY NUMBER: 197495009
VISIT DATE: 03/01/2022
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 On limits: Living/dining room, kitchen, bedroom, and bathroom. Living/dining room is where the main care will be provided. Children will be provided with meals and snack in the main care area. . Main care area will also be where nap time will be provided to the children in care. Bathroom was inspected. LPA observed adequate supply of soap and poster guidance of effective hand washing procedures during COVID-19 provided next to sink. 1 operable toilet, sink and no immediate or potential hazards.

Front yard is on limits and fenced in. Applicant stating that when children are having outside time that she will ensure 100% supervision and never leave children unattended. LPA observed two storage sheds in the play area. The sheds was observed to be locked.

Applicant was provided a Self-Assessment guide to follow in response to COVID-19 and was also informed that during today’s inspection that Licensing Program Analyst, Gutierrez provided Technical Assistance in response to reducing the spread of COVID-19. Applicant was informed to follow CDC guidelines and stay up to date with the Provider Information Notices while using best practices during the COVID-19 Pandemic.

Fire extinguisher (2A-10-BC) is located in the kitchen. Applicant has an inoperable Smoke and Carbon Monoxide detectors located in the bedroom. An accessible First Aid Kit equipped with, cleansing pads healing ointment, bandages, gauze, and a digital thermometer in closet of entrance of home.

Facility Administration: Applicant completed training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. Pediatric A certificate of completion of a course or courses in preventive health practices as defined in s subdivision (a) or certified copies of transcripts that identify the number of hours and the specific course or courses taken for training. (8 hours required) Preventative Health and Safety practices including childhood nutrition are completed and placed in facility file.

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SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2022
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DAVTYAN FAMILY CHILD CARE
FACILITY NUMBER: 197495009
VISIT DATE: 03/01/2022
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Applicant stated, There are no firearms and ammunition kept on the premises. LPA, Garibyan did not observe any of the above mentioned during today's inspection.

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, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with [applicant, 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 [applicant, 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.

APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS:

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: http://www.ada.gov/childqanda.htm



Transcripts verifying qualifications to grant a large family day care home have been reviewed, 7 courses in child development that qualify the applicant to instruct as a teacher in day care have been inspected and determined as alternate experience, if a large license is desired.

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SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2022
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DAVTYAN FAMILY CHILD CARE
FACILITY NUMBER: 197495009
VISIT DATE: 03/01/2022
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Applicant was informed that the following is pending licensure and needs to be corrected within 30 days from the date of this report

1) Pool fence

The applicant was advised the fence surrounding the pool shall be at least 5 feet high and constructed so that the fence does not obscure the view of the pool. The spacing between the horizontal bars/beams shall be no more than 45 inches. The distance between the ground and the bottom of the fence shall be no more than 4 inches from the hard surface(concrete). Fencing materials shall not be easily pushed over, broken, removed, or stretched by children. In addition fence shall not be easily climbable by children. The gate is self-closing and latching, and swings open away from the body of water. The latching mechanism shall be no more than six inches below the top of the gate.


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

Entrance Checklist was provided to the applicant.

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 platform.

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.

Exit interview conducted and report was reviewed with the applicant, Lusik Davtyan.

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SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2022
LIC809 (FAS) - (06/04)
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