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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019935
Report Date: 01/28/2020
Date Signed: 01/28/2020 03:06:43 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:PETROSYAN FAMILY CHILD CAREFACILITY NUMBER:
198019935
ADMINISTRATOR:KARINE PETROSYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 434-3571
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:14CENSUS: 4DATE:
01/28/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Karine Petrosyan, LicenseeTIME COMPLETED:
03:15 PM
NARRATIVE
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ANNUAL/RANDOM INSPECTION CONDUCTED IN ARMENIAN
Licensing Program Analysts (LPA) Anomeh Eivazian and Mayra Rivera conducted an unannounced random inspection. Upon LPAs' arrival licensee was not present in the home. LPAs met with licensee's husband, Harutyun Khachatryan. Shortly after licensee arrived who guided analyst on a tour of the facility. There were 4 children present during this inspection. Ms. Petrosyan states that there are currently 13 children enrolled, children's roster was reviewed and is current. Disaster drill log was available, last drill was conducted on 01/02/2020.

This is a one story home consists of 3 bedrooms, 3 restrooms, living room (day care room), dining room, kitchen, guest house in the backyard, laundry room, patio, front yard, and backyard (fenced). There is a fireplace in the dining room which has been blocked off to prevent access to children.

The children use the bathroom in the hallway, living room (day care room), dining room, and backyard (fenced). LPAs observed a safety gate was installed in the living room to make the satires which leads to the dining room inaccessible to the children. Also during this inspection licensee installed a safety gate to the kitchen to make it inaccessible to the children. Per licensee, areas off limits to children and parents include: 3 bedrooms, 2 bathrooms, kitchen, guest house in the backyard, patio, laundry room and front yard.**Rooms that are off-limits need to be made inaccessible during operating hours**. Family members residing in the home are 2 adults who have clearances on file and 2 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: 01/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020
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: PETROSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198019935
VISIT DATE: 01/28/2020
NARRATIVE
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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 but has not been serviced annually as it is required it was serviced on 06/12/2018, as indicated on service tag. 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 licensee's husband/assistant, Harutyun Khachatryan have proof of current pediatric first aid and CPR (expires: 06/2020). Licensee completed required mandated reporter training on 03/26/2018.

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.
LPAs 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. LPAs 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: 01/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020
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: PETROSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198019935
VISIT DATE: 01/28/2020
NARRATIVE
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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 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.

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.

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, Karine Petrosyan. 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: 01/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020
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: PETROSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198019935
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/28/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/21/2020
Section Cited

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Operation of a Family Child Care Home

Fireplaces and open-face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal.
This requirement has not been met as
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evidenced by LPAs personal observation. The valve on the required 2A 10BC fire extinguisher indicates fully charged, but has not been serviced annually as it is required it was serviced on 06/12/2018, as indicated on service tag.
This poses potential risk to the health and safety of 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: 01/28/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/28/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4