198006764-12-13-2023-33-CC-SSAN-CYGSAZ-20231213124310

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198006764
Report Date: 12/13/2023
Date Signed: 12/13/2023 12:43:18 PM

Document Has Been Signed on 12/13/2023 12:43 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	KHODAGULYAN FAMILY CHILD CARE		FACILITY NUMBER:	198006764
ADMINISTRATOR:	KHODAGULYAN, ALIS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 957-0042
CITY:	LA CRESCENTA	STATE: CA	ZIP CODE:	91214
CAPACITY:	14	CENSUS: 5	DATE:	12/13/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Alis Khodagulyan		TIME COMPLETED:	01:00 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	At 11:10 am Licensing Program Analyst (LPA) Suzana Safaryan and Nolan Tcheng conducted an unannounced required 3-year inspection to the above facility. A COVID risk assessment was conducted upon entry. LPA met with Licensee,Alice Khodagulyan to whom the reason for the visit was explained. Per Licensee, there are 6 children currently enrolled. There were 6 children and one adult (licensees’ assistant) Termine Mkrtchyan present upon arrival. The licensee was observed to be operating within the license capacity limitations. The licensee states that 2 adults and no children currently live in the home. All adults living in the home have obtained a criminal record clearance. This is a one-story home which consists of 3 bedrooms, 2 bathrooms, attic, living room, dining room, kitchen, detached garage , front yard, and backyard yard which is fenced. Per licensee, areas off limits to children and parents include attic , kitchen , living room, dining room, detached garage, and front yard. The children have access to daycare room, one bathroom, backyard which is fenced and bedrooms if necessary for additional play yards . Licensee guided analyst on a tour of the facility at 11:30 am. During this visit, all areas identified on the facility sketch that are accessible for children to use were toured and inspected and the following was observed. Parents drop off children from the back yard which leads directly to the daycare room . Page 1 of 4

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Shushanik Safaryan	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KHODAGULYAN FAMILY CHILD CARE	FACILITY NUMBER: 198006764
	VISIT DATE: 12/13/2023

NARRATIVE

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Facility License, Emergency Disaster Plan, Parent’s Rights Poster, and Earthquake Preparedness Checklist were observed to be posted in the daycare room . A current children’s roster was available for review.

There is telephone service via a cellphone and landline that stays at the facility during operation hours. Hours of operation are Monday – Friday, 07:30 am – 5:30 pm. There is central air and heating in the home. LPA observed fireplace in the living room that is screened making it inaccessible to children.

Detergents, cleaning compounds, and medications were observed to be inaccessible to children. Per Licensee, there are no poisons in the home. LPA advised that any poisons should be locked under key or combination lock. Licensee states that there are no firearms or weapons stored in the home.

The valve on the required 2A 10BC fire extinguisher indicates fully charged and LPA observed serviced tag 09/14/2023. Smoke and carbon monoxide detectors were tested and are operable.

All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. Last drill documented was conducted on 11/01/2023.

The home is observed to be clean and orderly. There are first aid supplies available in the bathroom . There are age-appropriate toys available for children.

Licensee states she is currently caring for 4 infants. LPA observed a sleep log ( LIC 9227) for each infant.

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SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Shushanik Safaryan	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KHODAGULYAN FAMILY CHILD CARE	FACILITY NUMBER: 198006764
	VISIT DATE: 12/13/2023

NARRATIVE

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Currently, children are using the side yard for outdoor play time. The outdoor play area was observed to be fenced and gated. LPA observed that the outdoor yard has toys and other materials for children to play with. No bodies of water were observed on this day.

At 11:50 am Licensee and staff records were reviewed. The licensee has completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 04/2025.Staff files were found to be complete .

LPA observed that the Licensee does have proof of Mandated Reporter AB 1207 compliant Child Care Training Certificate on file with expiration on 01/17/2024. www.mandatedreporterca.com

At 12:00 am children’s records were reviewed, including emergency information and were observed to be complete.

LPA created an LIC 857, Children’s Record Review, and LIC 859, Staff Record Review which documents staff and children’s files reviewed during this inspection.

Per licensee, there are no animals on the premises.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, and/or any other item that fall into these categories are not permitted in a family child care facility.

LPA also informed licensee, Alis Khodagulyan 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.

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SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Shushanik Safaryan	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KHODAGULYAN FAMILY CHILD CARE	FACILITY NUMBER: 198006764
	VISIT DATE: 12/13/2023

NARRATIVE

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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.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers

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.

Currently, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.

Exit interview conducted and report was reviewed with the licensee Alis Khodagulyan at 12:40 pm

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SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Shushanik Safaryan	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

LIC809 (FAS) - (06/04)

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