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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019587
Report Date: 12/12/2019
Date Signed: 12/12/2019 01:10:42 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:ISAHAKYAN FAMILY CHILD CAREFACILITY NUMBER:
198019587
ADMINISTRATOR:RUBINA ISAHAKYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 282-5189
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY:14CENSUS: DATE:
12/12/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Rubina IsahakyanTIME COMPLETED:
01:30 PM
NARRATIVE
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On 12/12/2019 at approximately 10:30 AM, Licensing Program Analyst, Stella Gutierrez met with Licensee, Rubina Isahakyan and explained the purpose of todays visit of an annual random inspection to ensure that facility is in compliance with Title 22 regulations and Health and Health Safety codes. Upon arrival, LPA observed 8 children ( 3 INFANTS and 5 Pre-Schoolers) being supervised by licensee and two assistants, Hranush Movsisyan and Lilit Sargsyan(Mother and Sister). Facility is license for a capacity of 14 children. Facility is operating within capacity limitations. All adults observed during today’s visit are fingerprinted and associated to the facility. Licensee guided LPA on a tour of the facility inside and out. Hours of operation are from 8:00 AM to 6:00 PM, Monday through Friday.

Areas identified in the sketch and observed by LPA, Gutierrez during today’s visit:
Interior:
This is a single-story dwelling, four -bedroom, one-bathroom home with kitchen/dining, living room, and an no garage. There is no pool, spa or other bodies of water on the premises. There are no weapons kept on the premises. Family members residing in the home include licensee and child. The facility was inspected inside and outside for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning when compounds, and hazardous items that can pose a danger to children.

On limits areas include, Living room, Bedroom #1, Bedroom #2, Bedroom #3 and Bathroom. (Facility sketch displays that Bedroom #1 and Bedroom # 3 are off limits) Licensee updated sketch during today's visit to display on limits for these areas. LIving room observed first entering the home. 6 high chairs and a pack n play yard. LPA, Gutierrez advised the licensee that high chairs are for the purpose of eating only. This is the main play area for the children while indoors. LPA observed age appropriate toys, learning materials, games and activities for children in care. Bedroom #1 (to the eft when entering the

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SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

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

DATE: 12/12/2019
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 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ISAHAKYAN FAMILY CHILD CARE
FACILITY NUMBER: 198019587
VISIT DATE: 12/12/2019
NARRATIVE
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hallway) - LPA observed 3 pack n plays and a child bouncer. LPA advised Licensee that the bouncer is prohibited for use at the family Child Care. LPA observed Licensee remove the bouncer from the home and place bouncer on side yard for trash during today’s visit. Bedroom #2 (Right when entering hallway) LPA Observed 1 pack n play and several craft and learning materials for the children in closet. This room also leads to outdoor area for children’s play though sliding glass doors. Bedroom #3 (all the way to end of the right of hall) LPA observed 1 pack n play, a bouncer and cots. Licensee immediately removed bouncer and placed in side yard with the other bouncer. This room is used for a napping area only. Age appropriate napping equipment (COTS) materials available and inspected for the preschool children. Bathroom across from Bedroom #2 is used for the children. LPA observed the bathroom to be in operable condition and free from hazards. All furniture was found in good repair, clean, and without hazards.

LPA observed a working smoke detector, operable carbon monoxide detector located in hall way area and 2A10-BC fire extinguisher in kitchen (serviced last June 2018) and a fully equipped first aid kit including a digital thermometer located in kitchen.

Off-limits areas include the following: Kitchen (child safety gate in place to make inaccessible) Bedroom #4 is the licensee and child’s place of sleep. Laundry area is in kitchen. Cleaners/chemicals observed under kitchen sink without latch and sharp objects in drawer to the right of sink without latches.

Exterior:

Inspection of the outdoor play area was conducted. Fencing around the perimeter of the back yard. There are two steps leading to outdoor area. Licensee was advised to properly supervise the children with assistance when going outside. LPA observed a small opening in wall that leads to under home about 1 foot wide and 6 inches tall with a broken screen. Licensee was advised that the screen shall be replaced. The screen did have any sharp places that could pose immediate danger to the children while playing outside. LPA, also observed a swing set, three slides, a picnic table, a play house and several tyke toy bikes (all on green turf) for the children to use while they are playing outside.

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SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

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

DATE: 12/12/2019
LIC809 (FAS) - (06/04)
Page: 2 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ISAHAKYAN FAMILY CHILD CARE
FACILITY NUMBER: 198019587
VISIT DATE: 12/12/2019
NARRATIVE
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Administration:

FORMS TO BE POSTED AND OBSERVED BY LPA during today’s visit


· LIC203 Facility License
· LIC 610A Emergency Disaster Plan
· LIC 9148 Earthquake Preparedness Checklist
· PUB394 Notification of Parents Rights Poster

Children’s roster observed and posted with other posting.

3 staff files and 8 children’s files were reviewed today.

(All children have immunization records and required forms are placed in files)

-Pediatric First Aid and Adult, Child and Infant CPR to be current (expires on 05/20/2021) for all staff

-Preventative Health and Safety was observed to be completed 02/18/2017 for all staff.

-No immunization records were available to LPA to observe today.

Mandated reporter Training certification observed for all staff certified on 09/08/2018. Licensee was advised to complete evert two years.

LPA discussed capacity limitations, new car seat law, personal rights, Notification of Parent's Rights revised 12/06, inspection authority & agency's consultative role. Smoking is prohibited on the premises when children are present. The LPA also discussed earthquake safety and necessity of drills every 6 months. The applicant was also informed that all adults living in or having access to day care children in the home are required to have fingerprint clearances with Department of Justice, FBI and Child Abuse Index prior to having contact with children. If the aforementioned is not adhered to, a Civil Penalty of $100 /day per uncleared adult will be assessed.

The facility is not currently providing IMS. Incidental Medical Services (IMS) policy was discussed with the Licensee. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. LPA obtained a copy of the facility's IMS Plan. The following information regarding

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SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

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

DATE: 12/12/2019
LIC809 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ISAHAKYAN FAMILY CHILD CARE
FACILITY NUMBER: 198019587
VISIT DATE: 12/12/2019
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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.html

The licensee was informed of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541.


Email Address: childcareadvocatesprogram@dss.ca.gov Safe Sleep Links:
AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx

NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative

Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

SIDS & SHAKEN BABY SYNDROME INFORMATION (discussed) flyer provided.


LPA provided safe sleep flyer and discussed safe sleep practice. Infants must be placed on their backs and must be physically checked every 15 minutes to gauge temperature and ensure they are breathing. Licensee, RUBINA ISAHAKYAN understands safe sleep practice for infants and to ensure supervision at all times infant’s are in care at ISAHAKYAN FAMILY CHILD CARE facility.

The following were also discussed with licensee:



Senate Bill 792: This bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles.

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SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

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

DATE: 12/12/2019
LIC809 (FAS) - (06/04)
Page: 6 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ISAHAKYAN FAMILY CHILD CARE
FACILITY NUMBER: 198019587
VISIT DATE: 12/12/2019
NARRATIVE
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New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment. A copy provider rights and Appeal process provided to Licensee. All appeals must be sent to:

California Department of Social Services | Community Care Licensing Division
300 Continental Blvd., Suite 290-A
El Segundo, CA 90245

New Immunization Requirement: Law enacted by SB 277, beginning January 1, 2016, personal beliefs exemptions will no longer be an option for the vaccines that are currently required for entry into child care or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint.

Assembly Bill 1207: California Child Care Workers; Mandated Training Requirement. Beginning January 1, 2018, all licensed providers, applicants, directors and employees must complete Mandated Reported Training prior to March 30, 2018 and renew training every two years at: www.mandatedreporterca.com. Volunteers are encouraged but not required to take the training. Providers are to complete the 4 hour General Training and 3 hour Child Care Provider Training. Licensee completed mandated reporter training on 09/08/2018.

Nutrition Requirement: Beginning January 1, 2016, AB 290 will require for each new license issued, at least one director or teacher at each child care center or family child care home to have at least one hour of training in the importance of childhood nutrition. This applies to anyone submitting a new application, relocating their facility, selling their facility or transferring their license. Please note this training cannot be completed online or by home study programs. The training must be taken from an Emergency Medical Services Authority (EMSA) approved training program OR an accredited college or university.

Assembly Bill 633: Upon receipt by the licensee, licensees are to provide to parents/guardians the following: Copies of any licensing reports that document a Type A citation- this includes facility visits and substantiated complaint investigations; copy of licensing documents pertaining to a conference conducted by a local licensing agency management representative and the licensee of this family child care home in which issues



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SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

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

DATE: 12/12/2019
LIC809 (FAS) - (06/04)
Page: 4 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ISAHAKYAN FAMILY CHILD CARE
FACILITY NUMBER: 198019587
VISIT DATE: 12/12/2019
NARRATIVE
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of noncompliance are discussed or copies of a summary of an accusation indicating the Department's intent to revoke the facility's license. Copies of any of the above licensing documents the licensee has received in the prior 12 months shall be provided to parents/guardians of newly enrolled child at the facility.

The Facility was found to be not to be in compliance per Title 22 regulations and Health and Safety Codes during today’s visit. There will be TYPE B deficiencies cited today.

An exit interview was conducted and a copy of this report, appeal rights along with the notice of site visit were provided to Licensee, Rubina Isahakyan

SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

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

DATE: 12/12/2019
LIC809 (FAS) - (06/04)
Page: 5 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ISAHAKYAN FAMILY CHILD CARE
FACILITY NUMBER: 198019587
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/19/2019
Section Cited

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1597.622
Employees or volunteers at family day care home; immunization requirements; records; exemptions a) (1) 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.
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Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

Based on today's observation this requirement was not met.
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Type B
12/19/2019
Section Cited

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102417
Operation of a Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger
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if readily available to children shall be stored where they are inaccessible to children.
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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: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:
DATE: 12/12/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/12/2019
LIC809 (FAS) - (06/04)
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