197411313-5-13-2019-30-CC-SGAN-BC5NTG-20190513104443

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197411313
Report Date: 05/10/2019
Date Signed: 05/13/2019 10:44:53 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	SAHAKYAN FAMILY CHILD CARE		FACILITY NUMBER:	197411313
ADMINISTRATOR:	SAHAKYAN, HRIPSIK		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 730-2326
CITY:	VALLEY VILLAGE	STATE: CA	ZIP CODE:	91607
CAPACITY:	14	CENSUS: 11	DATE:	05/10/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Hripsik Sahakyan		TIME COMPLETED:	03:05 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	Annual Random Visit Conducted In Armenian Licensing Program Analyst (LPA) Silva Garibyan conducted a site visit for the purpose of an Annual Random visit . LPA met with the licensee and toured the home inside and outside at 01:10 p.m on 05/10/2019. There were 11 children present at the time of the visit ( no infants). The licensee was present with her two assistants, Anait Karapetian and Svetlana Markosyan ( associated to the facility). The licensee's home is a single story 3 bedroom, 2 bathroom, dining room, kitchen and detached garage. There is no pool, spa or other bodies of water on the premises. Family members residing in the home include 2 adults ( licensee and her spouse) and no children. Main care is provided in the 2 bedrooms located at the rear and center, left side of the home. Off limit areas include the licensee's bedroom and bathroom, located at the front, left side of the home, the living room, dining room and kitchen. The garage is used for storage only and is off-limits to children. LPA observed tables, chairs and napping equipment. The main entry door will not be used to enter the facility; Parents and children will use the side gate to enter the facility leading to the back yard. Licensee reports she has no firearms or weapons in the home. The LPA toured all areas used by children during this inspection. The Fire Extinguisher (2A-10-BC) is mounted on the wall in the family room. There is a working smoke/carbon monoxide detectors located in the play room. LPA also observed Licensee's assistant's current Pediatric CPR (Adult/Infant /Child) and Pediatric First Aid certifications ( expire 09/2019) The First Aid kit was observed, and complete. LPA observed the fire drill log. The fire drills are done every six months. LPA observed toys and furniture that were age appropriate and in good repair. Page 1 of 3

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2019

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SAHAKYAN FAMILY CHILD CARE	FACILITY NUMBER: 197411313
	VISIT DATE: 05/10/2019

NARRATIVE

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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. Licensee's and assistants' immunization records are up to date.

Mandated Reporter: Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com. Armenian speaking only.

On May 10, 2019, the facility has been found operating within substantial compliance per the California Health & Safety Code(s) and Title 22 Regulation(s).

Exit interview was conducted and a copy of the report was provided

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SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SAHAKYAN FAMILY CHILD CARE	FACILITY NUMBER: 197411313
	VISIT DATE: 05/10/2019

NARRATIVE

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The outdoor play area (back yard) was inspected. The rear section of the back yard is fenced and children are not allowed in this area. The off-limits area extends to the right of the yard, behind the garage. LPA observed fruit trees and unused toys and various storage items in this area. There is a gate that remains closed, preventing children from accessing this area Children have plenty of toys to utilize for play.
Licensee has the following documents posted in the FCCH; Facility License (LIC 203), Notification of Parents' Rights Poster (PUB 394). Emergency Disaster Plan (LIC610a) was not posted in the facility. Licensee did not have a Facility Roster that included the ages of the children or their enrollment/last date in care.
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 Card.

The following was thoroughly discussed with the licensee:

Update on Incidental Medical Services:

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

New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment Page 2 of 3

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2019

LIC809 (FAS) - (06/04)

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