<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495067
Report Date: 03/03/2023
Date Signed: 03/03/2023 02:03:19 PM

Document Has Been Signed on 03/03/2023 02:03 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:ALAVERDYAN FAMILY CHILD CAEFACILITY NUMBER:
197495067
ADMINISTRATOR:SELINE ALAVERDYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(747) 214-6374
CITY:BURBANKSTATE: CAZIP CODE:
91501
CAPACITY: 14TOTAL ENROLLED CHILDREN: 13CENSUS: 9DATE:
03/03/2023
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
07:20 AM
MET WITH:Seline AlaverdyanTIME COMPLETED:
02:10 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
On 03/03/2023 Licensing Program Analyst (LPA) Deborah Lowe met with Licensee, Seline Alaverdyan. The purpose of the visit was an unannounced annual inspection at the home to ensure that health, safety and personal rights as requires by Title 22 and Health and Safety Regulations governing California Child Care Homes will be met. The Family Child Care Home operates Monday – Friday 7:00 a.m. – 11:00 p.m.

Upon arrival LPA Lowe observed 6 children under supervision of 3 adults.

At 10:53 am LPA Lowe observed 9 children under supervision of 2 adults.

LPA Lowe verified background clearance of staff present during visit. LPA observed S1 member without a background clearance.

LPA Lowe advised per CC Regulation 102370(d)(1) Criminal Record Clearance (d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department.

LPA Lowe advised Licensee will receive a Type A and a civil penalty of $500. Interview with Licensee and S1 LPA verified S1 has worked at facility for about nine months.

Review of facility sketch on file with the Department with the licensee showed changes to off-limits areas.

On limit areas observed during visit: Living room, bedroom 1, bedroom 2, bathroom located in hallway between bedrooms 1 & 2, outdoor backyard gated grass area. Home was observed to be single story.

Off limit areas observed during visit: Bedroom 3 (master bedroom), on suite bathroom, dinning room, kitchen, and back yard enclosed patio.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE: DATE: 03/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2023
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 11
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ALAVERDYAN FAMILY CHILD CAE
FACILITY NUMBER: 197495067
VISIT DATE: 03/03/2023
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
LPA advised per CC Regulation 102416.3(a)(6) Alterations to Existing Building or Grounds (a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.

LPA Lowe observed a working carbon monoxide detector in the home, LPA Lowe was able to hear a successful test. Smoke detectors are located in bedrooms 1 and 2. Fire extinguisher 2A10BC or larger was observed, located on enclosed patio. Electrical outlets were observed to safety outlets. The home was observed to be clean and orderly with heating and ventilation. LPA observed safe toys, play equipment, and materials. LPA Lowe verified the home has a working telephone service.

LPA advised, baby walkers, bouncer, Johnny jumper, trampoline, saucer chairs are not permitted.

LPA observed Clorox cleaning bottle on the counter accessible to children in the bathroom located in hallway between bedroom 1 and 2. Licensee removed Clorox bottle and placed in a located cabinet in the hallway.

LPA advised per CC Regulation 102417(g)(4) Operation of A Family Child Care Home (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

LPA advised poisons shall be locked with a key or a combination lock.

Cots were observed for napping. There were no cribs or pack-n-plays observed in the home. Per license, no infants under 12 months are enrolled at this time. LPA advised, there shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. LPA advised, the placement of cribs or play yards shall not hinder entrance or exit to and from the space where infants are sleeping. LPA advised, mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged. Mattresses shall be made specifically for the size crib or play yard in which they are placed. LPA advised, cribs or play yards shall be free from all loose articles, objects, bumper pads shall not be used, and there shall be no objects hanging above or attached to the side of the crib.

Per licensee, there are no firearms located in the home.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023
LIC809 (FAS) - (06/04)
Page: 11 of 11
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ALAVERDYAN FAMILY CHILD CAE
FACILITY NUMBER: 197495067
VISIT DATE: 03/03/2023
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
LPA Lowe observed a fireplace located in the living room. Living room was previously off-limits. Living room is now being used for care and supervision. Fireplace was observed without a secured barricade. Two ottomans and a round table were observed blocking the fireplace.

LPA advised per CC Regulation 102417(g)(1) Operation of A Family Child Care Home (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

Kitchen was observed to be off-limits to children; however, children walk through the kitchen dining room to access the nap rooms and bathroom. Child gate is up between living room and kitchen/ dinning area. Children were observed to be escorted to the bathroom one by one with staff. Kitchen was observed to be clean. Licensee stated they provide all food for the children.

Bathroom was observed to be clean with toilet and faucet safe and operable. Bathtub and shower are free of hazards.

Outdoor area is located back yard. Outdoor play area was observed to be a gated grass area. Patio located outside the kitchen door was observed to be an enclosed patio with door leading to backyard. Per licensee the patio is off-limits. LPA observed a separate building structure to the back of the property on the other side of a locked gate. Per licensee, the building structure to the back of the property belongs to the property owner License does not have access. LPA observed through windows property is empty, inside looks to be under construction.

When a child is ill, they will be separated from the other children. Isolation area will be located an on-limits bedroom.

Smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a). A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Sections 1596.846(b) and (c).

LPA Lowe reviewed 5 of children’s records and found 3 out of 5 records to be complete with emergency cards, immunization records, notification of parent’s rights. Two children’s files were observed with the Health Department immunization Blue card completed but did not have an immunization record.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023
LIC809 (FAS) - (06/04)
Page: 4 of 11
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ALAVERDYAN FAMILY CHILD CAE
FACILITY NUMBER: 197495067
VISIT DATE: 03/03/2023
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
LPA advised per CC Regulation 102418(g) Immunizations (g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

LPA Lowe observed the following postings: Facility license, LIC610A Emergency Disaster Plan and PUB 394 Notification of Parents’ Rights Poster. LPA observed Fire Drill Log.

LPA advised the licensee shall reveal each child care facility license number in all advertisements in accordance with Health and Safety Code Section 1596.861.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to [email protected]. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Licensee was reminded that all adults 18 and over living or working in the home, 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.

LPA discussed the safe sleep regulations with licensee 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 licensee 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.

LPA reviewed with Licensee 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.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023
LIC809 (FAS) - (06/04)
Page: 10 of 11
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ALAVERDYAN FAMILY CHILD CAE
FACILITY NUMBER: 197495067
VISIT DATE: 03/03/2023
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
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.

LPA Deborah Lowe informed licensee Seline Alaverdyan that this report dated 03/03/2023 document(s) one Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Deborah Lowe informed the licensee to provide a copy of this licensing report dated 03/03/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Appeal Rights were reviewed and provided.

Exit interview conducted and report was reviewed with the licensee Seline Alaverdyan).

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023
LIC809 (FAS) - (06/04)
Page: 7 of 11
Document Has Been Signed on 03/03/2023 02:03 PM - It Cannot Be Edited


Created By: Deborah Lowe On 03/03/2023 at 01:04 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ALAVERDYAN FAMILY CHILD CAE
FACILITY NUMBER: 197495067

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)(1)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above in S1 did not have a criminal record clearance which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/03/2023
Plan of Correction
1
2
3
4
LPA Lowe observed license send S1 home. Per licensee they will send S1 for Live Scan. Licensee provided LPA with a declaration of understanding of crimal background clearance requirments and that S1 will not return until background check comes back clear.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lisa Rios
LICENSING EVALUATOR NAME:Deborah Lowe
LICENSING EVALUATOR SIGNATURE:
DATE: 03/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2023


LIC809 (FAS) - (06/04)
Page: 5 of 11
Document Has Been Signed on 03/03/2023 02:03 PM - It Cannot Be Edited


Created By: Deborah Lowe On 03/03/2023 at 01:04 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ALAVERDYAN FAMILY CHILD CAE
FACILITY NUMBER: 197495067

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview with Licensee, the licensee did not comply with the section cited above in fire place in living room is without a barricade which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/06/2023
Plan of Correction
1
2
3
4
Licensee stated they will place a barricade in front of fireplace and will email a picture verification on or before the close of business on 03/06/2023.
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in a Clorox cleaning bottle was observedon the counter accessible in the children's designated bathroom which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/03/2023
Plan of Correction
1
2
3
4
Licensee corrected during visit. LPA observed licensee place Clorox bottle in a locked cabinet. During visit Licensee provided LPA with a declaration stating they understand all cleaning chemicals shall be inacessible to children at all times.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lisa Rios
LICENSING EVALUATOR NAME:Deborah Lowe
LICENSING EVALUATOR SIGNATURE:
DATE: 03/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2023


LIC809 (FAS) - (06/04)
Page: 2 of 11
Document Has Been Signed on 03/03/2023 02:03 PM - It Cannot Be Edited


Created By: Deborah Lowe On 03/03/2023 at 01:04 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ALAVERDYAN FAMILY CHILD CAE
FACILITY NUMBER: 197495067

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in licensee's mandated reporter expired and S1 and S2 do not have a completed mandated reporter training which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/10/2023
Plan of Correction
1
2
3
4
Licensee stated, Licensee and S2 will complete Mandated Reporter training. Licensee will email completed Mandated Reporter training certificates to LPA Lowe on or before close of business on 3/10/2023
Type B
Section Cited
CCR
102416.3(a)(6)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above in licensee did not notify the Department when changing the living room from "off-limits" to an area where now used for care and supervision of chidlren in care which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/06/2023
Plan of Correction
1
2
3
4
Per Licensee they will provide LPA Lowe with an updated facility sketch on or before the end of business on 03/06/2023.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lisa Rios
LICENSING EVALUATOR NAME:Deborah Lowe
LICENSING EVALUATOR SIGNATURE:
DATE: 03/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2023


LIC809 (FAS) - (06/04)
Page: 9 of 11