<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017011
Report Date: 10/22/2019
Date Signed: 10/22/2019 02:51:54 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:ADAMIAN FAMILY CHILD CAREFACILITY NUMBER:
198017011
ADMINISTRATOR:ADAMIAN, VERJIKFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 957-8995
CITY:LA CRESCENTASTATE: CAZIP CODE:
91214
CAPACITY:14CENSUS: 7DATE:
10/22/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Verjek Adamian, LicenseeTIME COMPLETED:
03:00 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
ANNUAL/RANDOM INSPECTION CONDUCTED IN ARMENIAN
Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced random inspection. LPA met with licensee, Verjek Adamian who guided analyst on a tour of the facility. Also present were Anahid Aivazian, licensee's assistant, Eric Adamian licensee's son, and Joseph Adamian, licensee's husband. There were 7 children present during this inspection, 4 being infants. Ms. Adamian states that there are currently 9 children enrolled, children's roster was reviewed and is current. Disaster drill log was available, last drill was conducted on 10/21/19.

This is a one story home which consists of 3 bedrooms, 2 and 1/2 bathrooms, kitchen, dining room, living room, den (activity room), garage, and backyard (fenced). The children use some part of living room, bathroom in the living room, den (activity room), and front part of backyard. Licensee make off limit areas inaccessible to the children by safety gates.
Per licensee, areas off limits to children and parents include: 3 bedrooms, some part of living room, dinning room, kitchen, 2 bathrooms, garage, and small yard in the back of the building. The licensee provides food for children in care. Family members residing in the home are 3 adults who have clearances on file and 0 children.

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 GabelmanTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2019
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 4
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: ADAMIAN FAMILY CHILD CARE
FACILITY NUMBER: 198017011
VISIT DATE: 10/22/2019
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
LPA explained to licensee that care 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 carries two millions liability insurance or a bond in accordance with standard established by Family Child Care statue.

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, Updated Patent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices which always Baby is sleeping on his/her back. 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.

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809d. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.
Exit interview was conducted with Licensee, Verjek Adamian. 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 GabelmanTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2019
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ADAMIAN FAMILY CHILD CARE
FACILITY NUMBER: 198017011
VISIT DATE: 10/22/2019
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 pets, weapons, firearms or bodies of water on the premises. 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 serviced on 08/22/19, as indicated on service tag. Smoke and carbon monoxide detectors in the living room were 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: 07/2020). Licensee, her assistant (licensee's son) did not complete required mandated reporter training at this time.

The following was discussed:


INFANT CARE: Licensee states that she does care for infants. Per licensee infants sleep in den and day care area in the living room under direct supervision.
Licensee states the following: Any infants in care will stay in the area where the licensee or assistant are.
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

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.


REPORT CONTINUES ON NEXT PAGE 2 of 3
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2019
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ADAMIAN FAMILY CHILD CARE
FACILITY NUMBER: 198017011
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/08/2019
Section Cited

1
2
3
4
5
6
7
On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of mandated reporter training every two years following
8
9
10
11
12
13
14
the date on which he or she completed the mandated reporter training. This requirement has not been met as evidenced by LPA's staff file review and licensee and licensee's son did complete the training at this time.
This poses a potential risk to the health and safety of children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:
DATE: 10/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/22/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4