Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419354
Report Date: 07/02/2015 12:00:00 AM
Date Signed 07/03/2015 04:44:00 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME:OGANESYAN & MARGARYAN FAMILY CHILD CAREFACILITY NUMBER:
197419354
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 7DATE:
07/02/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Heghine Hovsepyan---assistantTIME COMPLETED:
03:25 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Silva Garibyan conducted a site visit for the purpose of an Annual Random visit . LPA met with Licensee's assistant and toured the home inside and outside. There were 7 children ( 1 infant, 1 school age) present at the time of the visit. LIcensee's home is a two story dwelling with (3 bedrooms, 2 bathrooms, living room, detached garage, and a guest house in the back yard. Children eat and sleep in the living room, 2 bedrooms on the first floor, and in the kitchen. There is no pool, spa or other bodies of water on the premises. Family members residing at the facility are: 2 adults. Main care will be provided in the living room and two bedrooms on the first floor Off limit areas include the entire second floor, which consists of 1 bedroom and 1 bathroom, detached garage and the guest house. Applicant has a safety gate positioned at the bottom of the staircase, making the upper level inaccessible. Children utilize the bathroom located in the hall way (downstairs). . Licensee reports she has no firearms or weapons in the home. LPA also observed Licensee's assistant's current Pediatric CPR (Adult/Infant /Child) and Pediatric First Aid certifications (expire 03/2017).
The home was found to be clean and orderly with proper ventilation for safety and comfort. The bathroom was inspected for inaccessibility of chemicals/toxins and other potential hazards to children in care. The kitchen cabinets and drawers were inspected for inaccessibility of toxins/chemicals, knives and other sharp objects which may be harmful to children in care. The Fire Extinguisher (2A-10-BC) is mounted on the wall in the closet inaccessible to children in care. There is a working smoke and carbon monoxide detector located in the living room.
LPA observed toys and furniture that were age appropriate and in good repair. . LPA toured the backyard and found it to be fully fenced. There is no pool, spa or other bodies of water on the premises.. Children's outdoor play equipment and toys are age appropriate and in good repair.

Licensee has the required documents posted in the FCCH; Facility License (LIC 203), Emergency Disaster Plan (LIC610a), Notification of Parents' Rights Poster (PUB 394) 6, Child Care Facility Roster (LIC9040).

SUPERVISOR'S NAME: Mary RuizTELEPHONE: (310) 337-4826
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (310) 337-3754
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2015
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 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: OGANESYAN & MARGARYAN FAMILY CHILD CARE
FACILITY NUMBER: 197419354
VISIT DATE: 07/02/2015
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
A review of the children's records was conducted and are found to have the following: LIC 282 Affidavit Liability Insurance, LIC 627/Consent for Medical Treatment, LIC 700/ID and Emergency Information, LIC 995A/Parent's Rights, LIC995E/Caregiver Background Check, LIC 9150/Parent Notification, LIC 9212/Parent's Responsibilities, PM 286/Immunization (Blue) Card.

Exit interview conducted the following was discussed with the licensee:


Licensee was informed of responsibility to report suspected Child Abuse by calling the Child Abuse Hotline at 1-800-540-4000. Also call the Community Care Licensing office and follow up with a written Unusual Incident/Injury Report (LIC 624B).

The licensee was informed that the presence of adults in the home without Criminal Record Clearance or Exemption will be cited and civil penalty assessed for $100 per day. The licensee may find additional information and forms on the Department’s website at www.ccld.ca.gov including information on the Live Scan application (LIC 9163). Appointments can be made for Live Scan at 1-800-315-4507.

LPA discussed AB633 and informed licensee that, upon receipt of a Type A deficiency, the licensee shall post and provide copies of this licensing report to parent/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

Licensee is reminded that smoking is prohibited on the premises during hours of operation

SUPERVISOR'S NAME: Mary RuizTELEPHONE: (310) 337-4826
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (310) 337-3754
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2015
LIC809 (FAS) - (06/04)
Page: 2 of 2