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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017036
Report Date: 09/19/2019
Date Signed: 09/19/2019 12:19:10 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:AMADOR FAMILY CHILD CAREFACILITY NUMBER:
198017036
ADMINISTRATOR:AMADOR, SYLVIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 638-7278
CITY:GLENDALESTATE: CAZIP CODE:
91201
CAPACITY:14CENSUS: 1DATE:
09/19/2019
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
10:24 AM
MET WITH:Sylvia Amador, LicenseeTIME COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced random inspection. LPA met with Sylvia Amador, Licensee who guided analyst on a tour of the facility. During this inspection also was present Arsen Khoudanian, Licensee's Assistant. There was 1 licensee's biological child present during this inspection. Ms. Amador states that there are currently 4 children enrolled, children's roster was not available during this inspection. Disaster drill log was not available.

This is a one story home which consists of 3 bedrooms, 2 1/2 bathrooms, kitchen, dining room, living room
(FIREPLACE: inaccessible), den (children's play room), laundry room, garage and backyard (fenced). The children use the bathroom in the back room, dining room and den. The children use the backyard for outdoor play time. Per licensee, areas off limits to children and parents include: 2 bedrooms, 2 bathrooms, detached garage and the very back of the backyard. There is a fence, with a latch that keeps this area inaccessible to children. All areas identified that children use, were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating (central). The licensee provides food for children in care.

The licensee states that 2 adults and 2 children live in the home. 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.

PHYSICAL PLANT
Detergents, cleaning compounds, medications, and other items which could pose a danger were observed to be inaccessible to children during this inspection.. The licensee states that there are no poisons in the home.
REPORT CONTINUES ON THE NEXT PAGE 1 OF 4
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2019
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 6
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: AMADOR FAMILY CHILD CARE
FACILITY NUMBER: 198017036
VISIT DATE: 09/19/2019
NARRATIVE
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The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 08/20/19, as indicated on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. Smoke and carbon monoxide detector in the living room was tested, and is in operable condition. The home was observed to be clean and orderly during this inspection. There is heating and ventilation for safety and comfort. There are no stairs in the home. There are toys available for children.

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 08/02/2019. The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's does not have current Pediatric First Aid and CPR. There are first aid supplies available.

Children’s records were reviewed, including but not limited to, Immunization Records and Notification of Parents’ Rights receipt for children present. LPA issued the Confidential Names List (LIC 811) to the licensee during this inspection. The Confidential Names List (LIC 811) documents the staff and/or children’s files that were reviewed during this inspection. The licensee understand that arrangements must be made for a substitute adult to care and supervise children when they are absent from the home.

There was NO ZERO TOLERANCE deficiencies cited during this inspection. Zero Tolerance includes:
Absence of Supervision; Accessible Bodies of Water. No bodies of water on the premises; Accessible Firearms, Ammunition or Both. No firearms or weapons in the home; Refused Entry to a Facility or Any Part of a Facility in Violation of Section 1596.852, 1596.853 or 1597.09. Regulations 101238 (g)(2); The Presence of an Excluded Individual. No excluded individuals; Children are not left in parked vehicles. The facility does not transport children. Per Licensee, she picks up children from the school which is located cross street from the facility and walk to the home.

The following items were also discussed with licensee during this visit.
PETS: There is one dog on the premises.
POSTING REQUIREMENTS: Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted.
SMOKING IS PROHIBITED IN A LICENSED FAMILY CHILD CARE HOME.
REPORT CONTINUES ON THE NEXT PAGE 2 OF 4
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2019
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: AMADOR FAMILY CHILD CARE
FACILITY NUMBER: 198017036
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/11/2019
Section Cited

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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 subdivision (a), and shall complete renewal mandated reporter training every two years
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following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by licensee not having mandated reporter training certificate for her assistant, Arsen Khoudanian during inspection. This poses a potential health and safety risk to the children in care.
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Type B
10/11/2019
Section Cited

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Employees or volunteers at day care center; immunization requirements; records; exemptions - Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and
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volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by LPA determined that licensee and her assistant, Arsen Khoudanian do not have proof of immunization on file. This poses a potential health and safety risk to the children in care.
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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: 09/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2019
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: AMADOR FAMILY CHILD CARE
FACILITY NUMBER: 198017036
VISIT DATE: 09/19/2019
NARRATIVE
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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 and her assistant, Arsen Khoudanian do not have proof of immunization against influenza, pertussis, and measles.

H&S 1596.8662: Commencing January 1, 2018 all the licensed providers, applicants, directors and employees are required to complete training as specified on the mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Licensee completed required mandated reporter training on 03/01/2018. Licensee's assistant, Arsen Khoudanian does not completed mandated reporter training. Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com

INFANT CARE: Licensee states that she does care for infants. LPA discussed plan for supervising infants.
Licensee states the following: The licensee states that infants sleep in the back room next to the play area or between dining room and living room. The licensee states that she is in and out of the room that infants sleep in. LPA advised the licensee to sleep infants where they can be directly supervised and advised against sleeping infants in a separate room. If the licensee chooses to sleep infants in another room, the licensee is advised to conduct periodic checks to the room and a baby monitor is advised to also be used. LPA advised the licensee to sleep infants where the infant can be directly supervised and advised against sleeping 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

LPA advised the licensee how to access forms, regulations and quarterly updates, and provider information notices (PINS) on line at: www.ccld.ca.gov

REPORT CONTINUES ON THE NEXT PAGE 3 OF 4
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2019
LIC809 (FAS) - (06/04)
Page: 6 of 6
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: AMADOR FAMILY CHILD CARE
FACILITY NUMBER: 198017036
VISIT DATE: 09/19/2019
NARRATIVE
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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.

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.

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.

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.

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.

Exit interview was conducted with Licensee, Sylvia Amador. Appeal rights explained & provided.

REPORT END 4 of 4

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

DATE: 09/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2019
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: AMADOR FAMILY CHILD CARE
FACILITY NUMBER: 198017036
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/11/2019
Section Cited

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Operation of a Family Child Care Home.
All homes shall have a current roster of the children.

This requirement is not met as evidenced by LPA's file review and licensee does not have Children's current roster available during this inspection.
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This poses a potential health and safety risk to children in care.
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Type B
10/11/2019
Section Cited

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Personnel Requirements
The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
This requirement is not met as evidenced
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by LPA's file review and licensee does not havecurrent pediatric first aid and CPR .

This poses a potential health and safety risk to children in care.

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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: 09/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2019
LIC809 (FAS) - (06/04)
Page: 3 of 6