103908144-6-28-2021-04-CC-TMAZ-C4ERQ2-20210628131249

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103908144
Report Date: 06/28/2021
Date Signed: 06/28/2021 01:13:03 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	ANOOSHIAN, KATHERINE FAMILY CHILD CARE		FACILITY NUMBER:	103908144
ADMINISTRATOR:	ANOOSHIAN, KATHERINE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 287-0559
CITY:	FRESNO	STATE: CA	ZIP CODE:	93711
CAPACITY:	14	CENSUS: 0	DATE:	06/28/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Katherine Anooshian		TIME COMPLETED:	01:30 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 6/28/2021, Licensing Program Analysts (LPAs) Theresa Marquez and Kari McWilliams conducted an unannounced annual inspection and met with Licensee Katherine Anooshian. A tour of the home was conducted. There were no day care children present during todays inspection. Business hours are Monday through Thursday 9:00 AM to 12:15PM and other hours as arranged. Current facility sketch reviewed, and Licensee confirmed the living room, family room, play room, kitchen/dining area, and hall bathroom are used for providing care and are accessible to day care children. All other rooms are off-limits and are made inaccessible by use of safety gates. The fireplace located in the living room was made inaccessible to children by a glass door and will not be used during day care hours. Cooling and ventilation for safety and comfort. There were no stairs in the home. Safe toys and play equipment were observed. Licensee had a working telephone and the above telephone number was verified. LPA did not observe any poisons in the home. There is a working fire extinguisher, smoke detector and carbon monoxide indicator for safety and comfort. The outdoor play area in the backyard is fenced and there are no hazards to day care children. Licensee ensures that children in care are supervised at all times. There were no swimming pools, bodies of water, or firearms on the premises. Licensee is aware children shall not be left in parked vehicles and is aware car seats are used for transportation purposes only and are not used for sleeping children. LPA discussed Safe Sleep Regulations with Licensee.

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Theresa Marquez	TELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2021

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, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: ANOOSHIAN, KATHERINE FAMILY CHILD CARE	FACILITY NUMBER: 103908144
	VISIT DATE: 06/28/2021

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 sample of children’s records contained all emergency information specified by regulation. There were no excluded individuals present at this home. All adults who reside or work in the home had a criminal record clearance. A review of records indicated Licensee had proof of the required immunizations including the flu shot. Licensee's Mandated Reporter Training was completed on 3/20/2021. Licensee's pediatric CPR and First Aid expires on 4/12/2023.

Incidental Medical Services (IMS) are not currently provided. Licensee is aware that an IMS plan is required to be submitted to the Licensing Office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA information line at (800) 514-0301 (voice), (800) 514-0383 (TDD), and website link: https://www.ada.gov/childqanda.htm. http://www.ada.gov/childqanda.htm

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms, and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations no deficiencies were observed today.

Exit interview was conducted with Licensee. Licensee was provided a copy of the Facility Evaluation Report (LIC 809), and the Notice of Site Visit form (LIC 9213). The LIC 809 is required to remain in the facility for public review and the LIC 9213 is required to be posted for 30 days.

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Theresa Marquez	TELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2