198015912-7-26-2019-33-CC-CGRN-BEFS2T-20190726133004

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198015912
Report Date: 07/26/2019
Date Signed: 07/26/2019 01:30:11 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:	BOULGHOURJIAN FAMILY CHILD CARE		FACILITY NUMBER:	198015912
ADMINISTRATOR:	BOULGHOURJIAN, EMA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 636-4684
CITY:	PASADENA	STATE: CA	ZIP CODE:	91104
CAPACITY:	14	CENSUS: 7	DATE:	07/26/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Ema Boulghourjian		TIME COMPLETED:	01:40 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	Licensing Program Analysts (LPAs) Crystal Green and Jonah Myson conducted an unannounced annual inspection. LPAs met with Licensee, Ema Boulghourjian, who guided analyst on a tour of the facility. Also present during this inspection was Licensee Assistant, Mary Agulian. There were 7 children present, 3 being infants. The licensee states that there are currently 8 children enrolled, children's roster was reviewed and is current. Per license operating hours are from 7:30 AM - 5:00 PM, Monday - Friday. This is a one story home which consists of 4 bedrooms, back den (day care room), front den (TV room), 3 bathrooms, kitchen, dining room, living room (FIREPLACE: there is a fireplace which is inaccessible), detached room in the backyard, front yard, and backyard (fenced).The children use the bathroom in the hallway, back den (day-care room), two bedrooms, and backyard (fenced). Per licensee, areas off limits to children and parents include: living room, dining room, kitchen, 2 bedrooms, 2 bathroom, 1 den (TV Room), detached room, and front yard. The licensee provides food for children in care. The licensee state that 3 adults and 0 children live in the home. Licensee states that she currently has one assistant. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. The following was observed during this inspection. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for safety and comfort. There is a working telephone service maintained in the home. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible in all areas of the home. The licensee states that there are no poisons in the home. The licensee does understand that poison must be locked with a key or combination lock. Per licensee, there are no weapons, firearms or bodies of water on the premises. There were safe toys, play equipment, and materials observed for children. Emergency Disaster Plan, Parent’s Rights Poster, and the Facility License are observed to be posted. Report Continues Page 1 of 3.

SUPERVISOR'S NAME: Katherine Harewood	TELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2019

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: BOULGHOURJIAN FAMILY CHILD CARE	FACILITY NUMBER: 198015912
	VISIT DATE: 07/26/2019

NARRATIVE

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Children’s records were reviewed to ensure that each child has an Identification and Emergency form and Consent for Medical Treatment on file. The valve on the required 2A10BC fire extinguisher indicates fully charged last service date 05/2019.

Smoke detector and carbon monoxide detector are in operable condition. All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. The last drill documented was conducted on 06/24/2019. The licensee has current Pediatric First Aid and CPR, which will expire 05/2020.

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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at http://www.ada.gov/childqanda.htm

H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. The licensee's do have proof of immunization against influenza, pertussis, and measles.

AB1207 Mandated Child Abuse Reporting – Licensee and Licensee Assistant completed the online training with the certificate on file.

PROHIBITED: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that falls into these categories are not permitted in a family childcare facility. SMOKING IS PROHIBITED IN A LICENSED FAMILY CHILD CARE HOME.

Infant Care: Licensee states that she is currently caring for infants. LPA advised the licensee to sleep infants where they can be directly supervised at all times and advised the licensee against sleeping infants in a separate room.
The licensee stated the following as a supervision plan for infants: Licensee states that infants always sleep in the room with visual supervision. Report Continues Page 2 of 3.

SUPERVISOR'S NAME: Katherine Harewood	TELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2019

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

FACILITY NAME: BOULGHOURJIAN FAMILY CHILD CARE	FACILITY NUMBER: 198015912
	VISIT DATE: 07/26/2019

NARRATIVE

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LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing website at www.ccld.ca.gov

LPA issued a Confidential Names List (LIC 811) to the licensee which documents staff and children’s files 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.

The exit interview was conducted with Licensee. The Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.

Report Continues Page 3 of 3.

SUPERVISOR'S NAME: Katherine Harewood	TELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2019

LIC809 (FAS) - (06/04)

Page: 3 of 3