198013477-6-6-2023-12-CC-AVIA-CSJPGG-20230606111820

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198013477
Report Date: 06/06/2023
Date Signed: 06/06/2023 11:19:43 AM

Document Has Been Signed on 06/06/2023 11:19 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	MIRZAYAN FAMILY CHILD CARE		FACILITY NUMBER:	198013477
ADMINISTRATOR:	MIRZAYAN, HASMIK		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 631-5259
CITY:	SUNLAND	STATE: CA	ZIP CODE:	91040
CAPACITY:	14	CENSUS: 12	DATE:	06/06/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Hasmik Mirazayn, Licensee		TIME COMPLETED:	11:50 AM

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On June 6, 2023, Licensing Program Analysts (LPA) Annelise Villa met with licensee, Hasmik Mirzayan, who guided analyst on a tour of the facility for the One Year Required inspection. Upon arrival LPA observed 12 preschool age children in care and the licensee and two assistants. Family members residing in the home include Licensee and Licensee’s husband. Facility hours of operation are 7:00 am 6:00 pm. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: This is a one story family home. The home consists of a kitchen, living room, six bedrooms, 4 bathroom, daycare area, and front and back yards. The primary care for children is conducted in the daycare area. Bathroom #1 located in the daycare area on the right-hand side. The home was inspected inside and out for safety, comfort, cleanliness, orderliness, telephone service (land line), heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds and medicines are kept in the kitchen which is inaccessible and off limits to children in care, under the kitchen sink with an operable safety latch, sharp knives are kept in the kitchen in an upper drawer and are inaccessible to children. Children nap on mats or cribs in the daycare area.

Safe and age-appropriate toys, play equipment and materials were observed. The smoke detector, carbon monoxide detector and Fire Extinguisher (2A10BC) are all in operable condition. Electrical outlets are inaccessible. No recalled and or prohibited toys or sleep/ play equipment were observed on the premises. There is a designated area for ill children as necessary in the back of that daycare area. Per Licensee, there are no weapon/firearms in the home. The facility sketch is complete and current, there is working telephone (cell). Licensee is reminded to have the cell phone fully charged and available at all times.

Bathroom: LPA observed toilet and faucet are clean and operable. There are no shampoos or cleaning products in bathroom #1. Water temperature is appropriate and toilet paper and paper towels are readily available.

Continued on LIC 809-C

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Annelise Villa	TELEPHONE: 661-202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MIRZAYAN FAMILY CHILD CARE	FACILITY NUMBER: 198013477
	VISIT DATE: 06/06/2023

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Kitchen: The kitchen is off limits to children in care. Sharp utensils, open bottles or alcohol are inaccessible. The home has a clean and fully stocked refrigerator/freezer. Breakfast, lunch, dinner, and snacks are provided. Licensee stated she currently is a participant in a food program.

Outdoor: The front yard is off limits. The front yard is made inaccessible by a door with a lock. The front yard is completely fenced in. There is one dog on the premises. LPAs observed age-appropriate toys, well secured and safe for children.

Pools/Spas/Bodies of Water: There are no bodies of water in the premises.

Advisory/Other: First Aid kit was observed in the day care area with supplies readily available. CPR/First Aid expires 7/2025. Mandated Reporter expires 7/20/2024. LPA reminded licensee mandated reporter training and CPR must be completed every 2 years.

The facility annual fees are current. Licensee had all the required posted documents: Facility License (LIC 203), Notice of Parent's Rights Poster (PUB 394), Emergency Disaster Plan (LIC 610A), and Earthquake Preparedness Checklist (LIC 9148). Children files were found to be complete. Last fire/disaster drill log is maintained current and last drill was completed on 1/16/2023.

Documents Provided and or Discussed: Fire Drill Log, Postings, Employee's and Children's records, Safe Sleep PIN 20-24-CCP and Individual Sleeping Plan (LIC9227). Licensee currently does not have child care insurance.

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.

Continued on LIC 809-C

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Annelise Villa	TELEPHONE: 661-202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MIRZAYAN FAMILY CHILD CARE	FACILITY NUMBER: 198013477
	VISIT DATE: 06/06/2023

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LPAs discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAs 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.

No citations were issued today. An exit interview was conducted, a copy of this report was reviewed and provided to licensee along with the appeal rights.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Annelise Villa	TELEPHONE: 661-202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

LIC809 (FAS) - (06/04)

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