Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493491
Report Date: 07/20/2017
Date Signed 07/20/2017 10:26:43 AM

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:HARUTYUNYAN & LALAYAN FAMILY CHILD CAREFACILITY NUMBER:
197493491
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
07/20/2017
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
07:25 AM
MET WITH:SONA HARUTYUNYANTIME COMPLETED:
10:30 AM
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This is an announced pre-licensing visit conducted by Licensing Program Analyst (LPA), Silva Garibyan. LPA Garibyan met with the applicant, Sona Harutyunyan, who guided analyst on a tour of the facility. The applicant had no children in care today. The applicant does not carry child-care insurance. Applicant's home is a single story, 4 bedroom, 2 bathroom home with a living/dining room, kitchen, laundry room ( accessible from the yard), detached converted garage/recreation room ( with living room, bedroom, kitchenette, and bathroom). Family members residing at facility are: 3 adults ( applicant, spouse, and mother-in-law, all fingerprinted and associated ) and two children ( applicant's two sons, 12 years old). There is no pool, spa or other bodies of water on the premises. Main care will be provided in the kid's playroom/bedroom and infant nap room/bedroom in the back.. Off limit areas include living room, 2 front bedrooms, kitchen, laundry room, and the converted garage/recreation room. The children will have access to the bathroom located in the kid's playroom. Children will play in the back yard which is fenced. The main entry door will not be used to enter the facility. Parents and children will use the back door leading to the kids play room. Notification of Parents’ Rights Poster and Emergency Disaster Plan are posted. The applicant has attended preventive health and safety/Childhood Nutrition training. Pediatric CPR and First Aid expire 01/2018. Applicant has submitted a disaster plan and demonstrated control of property at the above address by presenting the Mortgage Statement.
The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. There are age appropriate toys and equipment on the premises. (Continued)

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

DATE: 07/20/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2017
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: HARUTYUNYAN & LALAYAN FAMILY CHILD CARE
FACILITY NUMBER: 197493491
VISIT DATE: 07/20/2017
NARRATIVE
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Regulation prohibits the smoking of tobacco in a private residence licensed as a family child care home during the hours of operation. State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.

The following was thoroughly discussed with the licensee:



Assembly Bill 633: Upon receipt by the licensee, licensees are to provide to parents/guardians the following: Copies of any licensing reports that document a Type A citation- this includes facility visits and substantiated complaint investigations; copy of licensing documents pertaining to a conference conducted by a local licensing agency management representative and the licensee of this family child care home in which issues of noncompliance are discussed or copies of a summary of an accusation indicating the Department's intent to revoke the facility's license. Copies of any of the above licensing documents the licensee has received in the prior 12 months shall be provided to parents/guardians of newly enrolled child at the facility.
Senate Bill 792: This bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles.
New Immunization Requirement: Law enacted by SB 277, beginning January 1, 2016, personal beliefs exemptions will no longer be an option for the vaccines that are currently required for entry into child care or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint.

New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment

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

Applicant is ready for licensure and will be licensed for a capacity of 8 childre

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

DATE: 07/20/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2017
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: HARUTYUNYAN & LALAYAN FAMILY CHILD CARE
FACILITY NUMBER: 197493491
VISIT DATE: 07/20/2017
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Appropriate fire extinguisher (2A10BC), smoke and carbon monoxide detectors are in operable condition. Home has central AC and heat. Applicant states there are no firearms or weapons of any kind in the facility at this time. First aid kit was observed and complete.

Applicant was informed that it is required by law to post the following in the facility:

● Emergency Disaster Plan (LIC 610A) - This must be posted in your home next to the telephone and


the Earthquake Preparedness Checklist (LIC 9148), must be attached to the LIC 610A and available
to the public.
● Notification of Parents' Rights Poster (PUB 394) - This poster must be placed in an area of the home
where all parents can see it
● Facility License, (LIC 203)-Your Family Child Care Home License must be posted in an area of the
home where it can be easily seen.
● Notice of Site Visit (LIC 9213) must remain posted for 30 days (during the hours that children are in
care) after each site visit by a licensing representative.
● Any licensing report documenting a type “A” citation must be posted for 30 days during the hours that children are in care.
● Any licensing report or other document verifying compliance or non-compliance with the Department’s order to correct a Type “A” deficiency must be posted for 30 days during the hours that children are in care.

Employee records must be maintained by the applicant and shall contain the following: LIC9052/Employee Rights, LIC 9108 Mandated Reporter Form, An employment contract or application containing the following information: Employees Full Name, Date of Birth, Driver's License Number, Date of Employment, Documentation of Health and Safety Training, Duties of the employee. Licensee is reminded that records for employees as well as children must be maintained for 3 years after separation for the FCCH.
Mandatory Forms for the children’s files: (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). Requirements for fire drills, earthquake drills, and documentation for both. Role and responsibilities of being a mandated reporter were reviewed. The applicant was advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov. (Continued)
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (310) 337-4826
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (310) 337-3754
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2017
LIC809 (FAS) - (06/04)
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