198013874-1-14-2020-33-CC-AEIN-BKTU4M-20200114141522

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198013874
Report Date: 01/14/2020
Date Signed: 01/14/2020 02:15:28 PM

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:	HAIRAPETIAN FAMILY CHILD CARE		FACILITY NUMBER:	198013874
ADMINISTRATOR:	HAIRAPETIAN, MADLEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 248-2628
CITY:	LA CRESCENTA	STATE: CA	ZIP CODE:	91214
CAPACITY:	14	CENSUS: 2	DATE:	01/14/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Madlen Hairapetian, Liccensee		TIME COMPLETED:	02:30 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	ANNUAL/RANDOM INSPECTION CONDUCTED IN ARMENIAN Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced random inspection. LPA met with licensee, Madlen Hairapetian who guided analyst on a tour of the facility. Also present was Kevin Bedrosian, licensee's son/assistant. There were 2 children present during this inspection, two being infants. Ms. Hairapetian states that there are currently 4 children enrolled, children's roster was reviewed and is current. Disaster drill log was available, last drill was conducted on 12/19/2019. This is a one story home which consists of 3 bedrooms, 1 and 1/2 bathrooms, kitchen, dining room, living room (FIREPLACE: inaccessible), detached converted garage, backyard (fenced), and front yard. The children use the 2 bedrooms, half bathroom adjacent to the kitchen, living room, dining room, front yard, back yard (fenced) and converted garage for limited activity only. During this inspection LPA observed two infants were sleeping inside the home, in two bedrooms. Per licensee, children eat either outside or inside the home and sleep inside the home. Per licensee, children use the converted garage for limited activity only, daily from 10 am to 11:30 am and 3:00 pm to 4:30 pm. Per licensee, parents enter the facility through the side gate which leads to the backyard. Per licensee, areas off limits to children and parents include: 1 bedroom, 1 bathroom in the hallway, and kitchen. LPA observed two safety gate was installed in the kitchen to make it inaccessible to the children. Family members residing in the home are 2 adults who have clearances on file and 1 child. All areas used by children were inspected for safety, comfort, cleanliness, telephone, ventilation and heating (central). The licensee states that there are no poisons in the home. The licensee understands that any poisons must be locked with a key or combination lock. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in all areas in the home. REPORT CONTINUES ON NEXT PAGE 1 of 3

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2020

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: HAIRAPETIAN FAMILY CHILD CARE	FACILITY NUMBER: 198013874
	VISIT DATE: 01/14/2020

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

Per licensee, there are no weapons, firearms or bodies of water on the premises. There is one dog on the premises, available to the day care children. There were toys observed for children. Posting requirements were observed to be posted at the time of inspection. Children’s records were reviewed. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was purchased on 04/04/2019, as indicated on the receipt. Smoke and carbon monoxide detectors in the hallway was tested, and are in operable condition. There are emergency supplies on the premises.

The licensee was observed to be operating within the licensed capacity and is not exceeding the required limitations. All adults present have obtained a criminal record clearance. The licensee has proof of current pediatric first aid and CPR (expires: 06/2020). Licensee and her son completed required mandated reporter training, certificates on file.Licensee completed the mandated reporter training on 06/05/2018 and licensee's son completed mandated reporter training on 07/12/2018.

The following was discussed:

INFANT CARE: Licensee states that she does care for infants. LPA discussed the licensee’s plan for supervising sleeping infants. Licensee states the following: Per licensee, infants sleep in the living room and two bedrooms. Per licensee, she has sound monitor for back bedroom and check infants periodically, every 15 minutes. LPA advised the licensee to sleep infants where the infant can be directly supervised and advised against sleeping infants in a separate room. The licensee states that she will not sleep infants in a separate room. LPA reviewed SIDs, Never Shake A Baby, and safe sleeping practices. Infants should sleep mouth up, on their backs, free of clutter surrounding their sleeping space. Safe sleep concepts were provided.

Medication: 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

REPORT CONTINUES ON NEXT PAGE 2 of 3

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2020

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: HAIRAPETIAN FAMILY CHILD CARE	FACILITY NUMBER: 198013874
	VISIT DATE: 01/14/2020

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

No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into this category are not permitted in a family child care facility.

LPA explained to licensee that car seat and stroller are only and only for transportation, high chair is only and only for feeding and stated items cannot be misused.

Per licensee, she does not carry liability insurance or a bond in accordance with standard established by Family Child Care statue. Signed statements (LIC282) on file. The law requires Family Child Care provider to carry liability insurance or bond in the amount of $300,000 annually or to maintain the singed statement in the facility file.

LPA reviewed and issued the LIC 311 - Forms/Records to Keep in Your Family Child Care Home.
LPA advised the licensee how to access forms, regulations and quarterly updates , and Providers Information Notices (PIN) on line at: www.ccld.ca.gov

LPA consulted and explained Child Abuse Reporting, Effects of Lead Exposure flyer, Updated Patent’s Rights Poster with Complaint Hotline information, Capacity Handout (Small & Large) was provided during this inspection. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report). Licensees shall reveal each facility license number in all advertisements, publications, or announcements made with the intent to attract clients. Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com

LPA issued the Confidential Names List (LIC 811) to the licensee during this inspection. The Confidential Names List documents the children’s files that were reviewed during this inspection.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today. Exit interview was conducted with Licensee, Madlen Hairapetian. Appeal rights explained & provided. A copy of this report and all other Licensing reports must be made available to the public for 3 years.
REPORT END 3 of 3

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2020

LIC809 (FAS) - (06/04)

Page: 3 of 3