Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419360
Report Date: 02/24/2016
Date Signed 02/24/2016 03:26:02 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:HAYRAPETYAN FAMILY CHILD CAREFACILITY NUMBER:
197419360
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
02/24/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Lilit HayrapetyanTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Silva Garibyan conducted a site visit for the purpose of an Annual Random visit . The licensee has applied for capacity increase. LPA met with the licensee and toured the home inside and outside. The licensee was present with 6 children ( 2 infants). The licensee has installed the pull fire alarm that is required for large Family Child Care Homes and have an approved fire clearance. This is a two story 3 bedroom, 2 bathroom home with living room, kitchen, rear family room and detached garage that is used for storage only. There is no pool, spa or other bodies of water on the premises. Family members residing in the home include 2 adults (applicant and spouse) and 4 children ( 14, 11, 8, and 7 years old). Applicant has 1 large dog that is kept in the back yard area, off-limits to children. Main care is provided in the rear living/family room. Children have access to the bathroom accessible from the hallway near the front living room. Children have access to the kitchen area and the living room. Children play in the front yard only. There is a driveway along the left side of the home with a fence that restricts access to the rear yard. Off limit areas include the second floor which consists only of 1 bedroom. Licensee has a safety gate for the staircase. The third bedroom is occupied by the licensee's daughter and is not used for child care activities. The second bathroom is located inside the licensee's bedroom and inaccessible to the children in care.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 kitchen inaccessible to children in care. The home has a fireplace in the living room that is barricaded by a dining table.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (310) 337-4826
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (310) 337-3754
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2016
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, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: HAYRAPETYAN FAMILY CHILD CARE
FACILITY NUMBER: 197419360
VISIT DATE: 02/24/2016
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There is a working smoke/carbon monoxide detector located in the play room. Licensee has current CPR/First Aid Certificates ( expired 2/2018).
Licensee reports there are no firearms or weapons in the home. The First Aid kit was observed, and complete.
Licensee has the required documents posted in the FCCH; Facility License (LIC 203), Emergency Disaster Plan (LIC610a), Notification of Parents' Rights Poster (PUB 394) , Child Care Facility Roster (LIC9040).


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.

Incidental Medical Services were discussed. Per licensee incidental medical services are not and will not be provided.


Capacity and Ratios: The licensee has applied for a capacity increase for a large family . The Max capacity is 12 with no more than 4 infants and a qualified assistant. Without a qualified assistant the license reverts back to the requirements for a small family childcare. Optional care may be provided for a maximum capacity of 14 children with no more then 3 infants, 2 school age children and a qualified assistant. School age children must be 1 age 6 yrs and 1 in Kindergarten.

Exit interview conducted and a copy of the report provided.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (310) 337-4826
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (310) 337-3754
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2016
LIC809 (FAS) - (06/04)
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