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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198006764
Report Date: 03/22/2022
Date Signed: 03/22/2022 02:05:58 PM


Document Has Been Signed on 03/22/2022 02:05 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:KHODAGULYAN FAMILY CHILD CAREFACILITY NUMBER:
198006764
ADMINISTRATOR:KHODAGULYAN, ALISFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 957-0042
CITY:LA CRESCENTASTATE: CAZIP CODE:
91214
CAPACITY:14CENSUS: 10DATE:
03/22/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Alis Khodagulyan, LicenseeTIME COMPLETED:
02:20 PM
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CASE MANAGEMENT INSPECTION CONDUCTED IN ARMENIAN
Licensing Program Analysts (LPA) Anomeh Eivazian and David Kurdoglyan conducted an unannounced case management inspection to the above facility on 03/22/2022 due to the construction that licensee has in the backyard and changes in the facility sketch. LPAs arrived at the facility at 12:40 PM and met with Alis Khodagulyan, Licensee who guided analysts on a tour of the facility. Also present during this inspection, was Medik Yaghoubi, Licensee’s Assistant. Per licensee, Alis Khodagulyan facility hours are Monday to Friday from 7:30 a.m. to 5:30 p.m.. During this inspection individuals who reside in the home were discussed and notes on Confidential Name List (LIC811) and attached to this report.

This is a one story home which consists of 3 bedrooms, 3 bathrooms, kitchen, dining room, living room (FIREPLACE: which is inaccessible), attic, front yard, backyard (fenced) and garage. The children use the bathroom in the hallway, living room, dining room, kitchen, three bedrooms and backyard (fenced). Per licensee, areas off limits to children and parents include: Front yard, garage, and attic. LPAs observed six feet high fencing in the backyard which separated the construction areas in the backyard from daycare area. Per licensee, parents enter the facility through the side gate which leads to the daycare bedrooms. An updated facility sketch was submitted to LPA during this inspection.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. At 12:50 p.m., Licensee took this LPAs on a tour of the home. LPAs was toured through the interior starting with the living room and dining room, LPAs observed sofas, a coffee table, a TV in the living room, dining table and chairs in the dining room. Next LPAs toured the kitchen and observed knives and sharp items in a high level cabinet out of reach of children. Next LPA toured the bathroom in the hallway and did not observe any hazards in the bathroom. Next LPAs toured the three daycare bedrooms, LPAs observed 8 children, 2 being infants were napping in the middle bedroom with licensee's assistant. LPAs observed one infant in pack 'n play in left side bedroom and one infant in pack 'n play in right side bedroom. LPAs observed all electrical outlets were covered in daycare area.
REPORT CONTINUES ON NEXT PAGE 1 of 3
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2022
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 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: KHODAGULYAN FAMILY CHILD CARE
FACILITY NUMBER: 198006764
VISIT DATE: 03/22/2022
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Next LPAs toured the backyard fenced. Currently, children are using the back yard for outdoor play time. The outdoor play area was observed to be fenced. LPAs observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that can pose a danger to children on the outdoor yard. The licensee states that supervision is always provided.

INFANT CARE: Licensee states that she cares infants. Licensee states that infants sleep in the three bedrooms. Appropriate sleeping arrangements and cribs were observed. (one crib for each infant in care was observed). Cribs or play yard did not hinder the entrance or exit from the sleeping space in the daycare bedrooms, mattresses shall be firm and covered with a fitted sheet that overlaps the underside so it cannot be dislodged. Cribs and play yards were observed to be free of loose articles and objects. No objects were observed to be hanging above or attached to the side of the crib. LPAs did not observe any infants swaddled while in care. LPAs advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. A copy of the LIC 9227 was provided to Licensee. LPA provided the licensee with a copy of A Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. LPA also consulted and explained Child Abuse Reporting, Never Shake a Baby, and Safe Sleeping practices.

SAFE SLEEP: LPA discussed the safe sleep regulations with licensee, and discussed the Child Care Licensing Safe Sleep webpage at http://www.cdss.ca.gov/inforescources/child-care-licensing/public-information-and-resoucrces/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 http://www/cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. Boppy recall: https://www.cpsc.gov/Recalls/2021/The-Boppy-Company-Recalls-Over-3-Million-Original-Newborn-Loungers-Boppy-Preferred-Newborn-Loungers-and-Pottery-Barn-Kids-Boppy-Newborn-Loungers-After-8-Infant-Deaths-Suffocation-Risk
REPORT CONTINUES ON NEXT PAGE 2 of 3
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: KHODAGULYAN FAMILY CHILD CARE
FACILITY NUMBER: 198006764
VISIT DATE: 03/22/2022
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At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today from the areas that were inspected today.

LPA advised the licensee to access forms, regulations and quarterly updates online at: www.ccld.ca.gov. LPA also discussed the Provider Information Notices (PINS) on Safe Sleep Awareness: PIN 19-02-CCP,
U.S. CONSUMER PRODUCT SAFETY COMMISSION FISHER-PRICE INFANT EQUIPMENT RECALLS: PIN 20-19 CCP COVID FAQ - PIN 20-11-CCP, Required Lead Testing: PIN 20-01 CCP Effects of Lead Exposure, and Guardian User Account Access - PIN 20-20-CCLD, UPDATED GUIDANCE FOR CHILD CARE PROVIDERS REGARDING CORONAVIRUS DISEASE (COVID-19), PIN 22-10- CCP.

LPA Eivazian asked licensee once the construction is completed in the backyard to submit an updated facility sketch to LPA.

The Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Licensee, Alis Khodagulyan at 2:20 p.m..


REPORT END 3 of 3
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3