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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017514
Report Date: 12/03/2019
Date Signed: 12/03/2019 02:48:16 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:GALOUSTIAN FAMILY CHILD CAREFACILITY NUMBER:
198017514
ADMINISTRATOR:JENIK GALOUSTIANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 395-1717
CITY:GLENDALESTATE: CAZIP CODE:
91201
CAPACITY:14CENSUS: 7DATE:
12/03/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Jenik Galoustian, LicenseeTIME COMPLETED:
03:00 PM
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ANNUAL/RANDOM INSPECTION CONDUCTED IN ARMENIAN

Licensing Program Analysts(LPA) Anomeh Eivazian and Monique Ayala conducted an unannounced random inspection to the above facility. LPAs met with Sevan Manougian, Licensee assistant/daughter who guided analyst on a tour of the facility. Licensee, Jenik Galoustian was also present in the home. Also present during this inspection, were Nareg Manougian, licensee's son, and George Manougian, licensee's husband. The licensee states that she currently has 10 children enrolled, two being licensee's daughter's children. A current children’s roster was available and is current. During this inspection there were 7 children present in the facility, 2 being infants.

This is a one story home which consists of 3 bedrooms, 3 bathrooms, kitchen, living room, dining room, family room (FIREPLACE: which is inaccessible), garage, front yard, and backyard (fenced). The children use the bathroom in the hallway, living room, dining room, and backyard (fenced). Per licensee, areas off limits to children and parents include: 2 bathrooms, 3 bedrooms, family room, front yard, and garage. The licensee provides food for children in care. Per licensee children line up and under supervision walk through family room to the backyard (fenced). Family members residing in the home are 4 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: 12/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2019
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: GALOUSTIAN FAMILY CHILD CARE
FACILITY NUMBER: 198017514
VISIT DATE: 12/03/2019
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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 purchased on 02/07/19, as indicated on receipt. Smoke and carbon monoxide detectors 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 and her assistant have proof of current pediatric first aid and CPR (expire: 03/2020). Licensee and her assistant completed required mandated reporter training, certificates on files.

The following was discussed:


INFANT CARE: Licensee states that she does care for infants. LPAs discussed the licensee’s plan for supervising sleeping infants. 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: 12/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2019
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: GALOUSTIAN FAMILY CHILD CARE
FACILITY NUMBER: 198017514
VISIT DATE: 12/03/2019
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LPAs 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 carries liability insurance for two millions in accordance with standard established by Family Child Care statue.

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

LPAs 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

LPAs 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, JenikGaloustian. 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: 12/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3