Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493491
Report Date: 12/22/2017
Date Signed 12/22/2017 12:38:27 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:HARUTYUNYAN FAMILY CHILD CAREFACILITY NUMBER:
197493491
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
12/22/2017
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Sona HarutyunyanTIME COMPLETED:
12:40 PM
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Licensing Program Analyst (LPA) Silva Garibyan conducted a Case Management visit for capacity increase to 14 children. Currently the licensee is licensed for a small FCCH with a maximum capacity of 8 children. The LPA met with the licensee, Sona Harutyunyan. Licensee has proof of teaching experience, has provided a certificate of completion in Early Childhood Education and qualifies for a large family child care license. 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. Per the licensee there has been no noted changes to the home or occupants since her last visit ( Pre-licensing visit conducted on 7/20/17.). The applicant has installed the pull fire alarm that is required for large Family Child Care Homes
LPA observed four children were present. One child was infant and three children were preschool age.

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

Licensee has the following documents posted in the FCCH; Facility License (LIC 203), Child Care Facility Roster (LIC9040), and Emergency Disaster Plan (LIC610a). LPA did not observe the Parent's Rights poster to be posted in a prominent area of the home.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (310) 337-4826
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (310) 337-3754
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2017
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 FAMILY CHILD CARE
FACILITY NUMBER: 197493491
VISIT DATE: 12/22/2017
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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 max 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.
Capacity increase is pending Fire clearance only. When Fire clearance has been received file will be submitted for increase approval.
No Deficiencies are being cited on this date.

An exit interview was conducted and a copy of the report was provided.

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

DATE: 12/22/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2017
LIC809 (FAS) - (06/04)
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