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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021508
Report Date: 06/21/2024
Date Signed: 06/21/2024 03:10:16 PM

Document Has Been Signed on 06/21/2024 03:10 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:DAVTYAN FAMILY CHILD CAREFACILITY NUMBER:
198021508
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/21/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 AM
MET WITH:Ruben Davtyan and Gohar Sirakanyan, applicantsTIME VISIT/
INSPECTION COMPLETED:
03:10 PM
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PRELICENSING INSPECTION CONDUCTED IN ARMENIAN
Licensing Program Analyst (LPA) Anomeh Eivazian conducted an announced pre-licensing inspection to the above facility on 06/21/24. LPA arrived at the facility at 12:00 PM and met with Gohar Sirakanyan and Ruben Davtyan, Applicants who guided analyst on a tour of the facility. Pre-licensing Entrance Checklist (LIC9280) was provided to applicants, Gohar Sirakanyan and Ruben Davtyan. During this inspection individuals who reside in the home were discussed and notes on Confidential Name List (LIC811) and attached to this report. A COVID 19 risk assessment was conducted prior to entering the facility. Per applicants operation hours will be Monday to Saturday, 6:00 a.m. to 11:00 p.m.. Applicant states she will care for children 0-14 years old.

All areas identified on the facility sketch were inspected. This is a one-story home located on the first level. The home consists of 3 bedrooms, 2 restrooms, living room, family room, dining room, kitchen, laundry room, detached garage, front yard, and backyard (fenced). Per applicants, parents will enter the home through the main entrance which leads to the living room or side gate which leads to the backyard.

Areas that are accessible to children are as follows: Bathroom in the hallway adjacent to the kitchen, living room, family room, kitchen, dining room, laundry room, and back of backyard (fenced).

Areas off limits based on facility sketch submitted to children and parents include: Three bedrooms, one bathroom in the hallway of bedrooms, front yard, detached garage, and back yard (cement area).
**Rooms that are off-limits need to be made inaccessible during operating hours**

The applicant does understand that licensing staff may have access to off-limit areas during inspection if necessary.
REPORT CONTINUES ON NEXT PAGE 1 of 6
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2024
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: DAVTYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021508
VISIT DATE: 06/21/2024
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At 12:45 pm, the applicants began touring LPA’s through the home starting with the entry way which lead directly to the living room (daycare area). The living room was inspected, and electrical outlets were observed to be covered. There is a fireplace in the living room which has been covered to prevent access. Next LPA toured the dining room and observed children tables and chairs in the dining room. There is a door in the dining room which leads to the two off-limit bedrooms and one off-limit bathroom. Per applicants, they will keep the dining room door closed all the times to make the off-limit bedrooms and one off-limit bathroom inaccessible to the children. Next LPA toured the two off-limit bedrooms and one off-limit bathroom and did not observe any hazards. Next LPA toured the kitchen and observed accessible knives and sharp items in the kitchen. Next LPA toured the laundry room and did not observe any hazards. Next LPA toured the one daycare bathroom and did not observe any hazards. Next LPA toured the family room and observed a dining table, chairs, and a sofa in the dining room. There is a door in the dining room which leads to the backyard. Next LPA toured the off-limit bedroom adjacent to the dining room and did not observe any hazards. LPA observed the required 2A 10BC fire extinguisher was placed on the cabinet in the family room. It was purchased on 06/03/24 as read by LPA from the receipt. Applicant tested the carbon monoxide and smoke detector in the family room. It sounded off the alarms and heard by LPA to be functional.

Next LPA toured the backyard fenced. Per applicants, children will use the back of back yard for outdoor play time. Daycare outdoor playarea was fenced by three feet high vinyl gate to be separated from off-limit areas in the backyard. LPA observed the outdoor playarea ground was turf. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that can pose a danger to children on the outdoor yard. Next LPA toured the detached off-limit garage and did not observe any hazards. Per applicants, they will keep the off-limit garage door closed all the times during daycare hours. Per applicants, children will walk through the family room door to the backyard. The applicants state that supervision is always provided.



APPLICANTS RENT THE HOME: The applicants provided proof of control of property.
APPLICANTS RENTTHE HOME AND HAS LANDLORD CONSENT: Because the applicants rent/lease the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicants confirm was provided to the property owner/landlord. The applicants obtained a signed Property Owner/Landlord Consent form (LIC 9149). Applicants confirmed that LIC 9149 was signed by landlord.
REPORT CONTINUES ON NEXT PAGE 2 of 6
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: DAVTYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021508
VISIT DATE: 06/21/2024
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The applicants state that they will provide food for children in care. Applicants were advised that if food is brought from the children’s homes, all containers must be labeled with child’s name and properly stored or refrigerated. Per applicants, at 1:40 pm, there are no pets, weapons, firearms or bodies of water on the premises. There are toys available for children. There is telephone service via a cellphone that is used, and the cellphone stays at the facility during operation hours. LPA advised applicant that if a child shows signs of illness he/she/they shall be separated from other children. Per applicants, her husband/his father smokes in the home but not in the daycare area. There are first aid kit in the home, in the living room. Per applicants, they will provide transportation in it will be needed.

Applicants has proof of CPR and First Aid training as indicated on the certificate. The applicants do have proof of Health and Safety training (completion date: Ruben Davtyan: 04/13/24 and Gohar Sirakanyan: 02/20/21), Pediatric First Aid and CPR (ex. Ruben Davtyan: 04/26 and Gohar Sirakanyan: 08/25). The applicants have proof of immunization against influenza, pertussis, and measles.
Applicants completed required mandated reporter training on Ruben Davtyan: 04/16/24 and Gohar Sirakanyan:10/19/23. Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com

The following was discussed with the applicant:
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.

-In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.


-A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
REPORT CONTINUES ON NEXT PAGE 3 of 6
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024
LIC809 (FAS) - (06/04)
Page: 3 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: DAVTYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021508
VISIT DATE: 06/21/2024
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-Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License shall be terminated.
-The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should check and batteries replaced as needed.
-Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
-Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report)
-Fire and safety drills must be performed every six months and documented for review by the Department.
-Smoking is prohibited in a family child care home.
-Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
-Dog(s) and or pets are recommended to be isolated from children in care.
-No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.
-All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
- Applicant shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.
- Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.

INFANT CARE: Applicants state that they will care for infants. Applicants state that infants will sleep in the living room, dining room and family room where they are constantly supervised. LPA informed Applicant infants can not be swaddled while in care. LPA advised the Applicant that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. A copy of the LIC 9227 was provided to Applicant.
REPORT CONTINUES ON NEXT PAGE 4 of 6
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: DAVTYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021508
VISIT DATE: 06/21/2024
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SAFE SLEEP: LPA discussed the safe sleep regulations with applicant 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 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.

Medication: Incidental Medical Services (IMS) policy was discussed .For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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.

Per applicants, there are no dual licenses at this address. Applicants’ email address was obtained during this inspection. The applicants were advised that email may be public information.



Per applicants, they do not carry liability insurance or a bond in accordance with standard established by Family Child Care statue. Signed statements (LIC282) will be on children’s files. The law requires Family Child Care provider to carry liability insurance or bond in the amount of $300,000 annually or to maintain the signed statement in the facility file.

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.


REPORT CONTINUES ON NEXT PAGE 5 of 6
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: DAVTYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021508
VISIT DATE: 06/21/2024
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Megan’s Law - Family Child Care Homes On this date, 06/03/24, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

MyChildCarePlan.org--Child Care Centers and Family Child Care Home applicants were informed of the MyChildCarePlan.org site, 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

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.

The following corrections need to be corrected prior to obtaining a small family child care license. Corrections are due by 07/22/24:


1. Applicants will submit copies of CA ID to reflect facility address.
2. Applicants will add a plastic door knob on the main entrance door.
3. Applicants will submit TB test clearance for Ashot Davtyan.
4. Applicants will add railing to two stairs outside of family room for additional safety.
5. Applicants will make knives and sharp items inaccessible to the children in the kitchen.
6. Applicants will submit Family Child Care Home orientation certificate for Gohar Sirakanyan.
7. Applicants will have a pack n' play.
8. Applicants will add self-closing latch to the side gate, out of reach of children for additional safety.
A small family child care license will be granted upon receipt of proof of corrections for the above. Once licensed, the applicants are required to adhere to the terms and limitations stated on the license.

The applicants’ signature on this report acknowledges that they have signed the Application for a Family Child Care Home License (LIC 279) under the penalty of perjury that the statements on the application and any attachments are correct.
Exit interview conducted and report was reviewed with the applicants, Ruben Davtyan and Gohar Sirakanyan.
REPORT END 6 of 6
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024
LIC809 (FAS) - (06/04)
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