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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020183
Report Date: 01/09/2020
Date Signed: 01/09/2020 12:22:42 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:ADAMYAN FAMILY CHILD CAREFACILITY NUMBER:
198020183
ADMINISTRATOR:ANNA ADAMYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 507-9068
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:14CENSUS: 9DATE:
01/09/2020
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Anna Adamyan, LicenseeTIME COMPLETED:
12:30 PM
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ANNUAL/RANDOM INSPECTION CONDUCTED IN ARMENIAN
Licensing Program Analysts (LPA) Anomeh Eivazian and Jennifer Anguiano conducted an unannounced required 1-year random inspection. LPAs met with licensee, Anna Adamayn who guided analyst on a tour of the facility. Also present were Susanna Adamyan, licensee's assistant and Arman Khurshudyan, licensee's son. There were 9 children present during this inspection, 3 being infants. Ms. Adamyan states that there are currently 11 children enrolled, children's roster was reviewed and is current. Disaster drill log was available, last drill was conducted on 11/07/2019.

This is a one story home which consists 3 bedrooms, 3 restrooms, living room, dining room, kitchen, converted garage, laundry room, attic, front yard and fenced back yard (fenced). There is a in ground pool on the premises in the backyard. Pool is inaccessible and surrounded with six feet high fences, with less than 4 inches opening. Also gates swing away from the pool, self-closed and have a self-latching device located no more than six inches from the top of the gate. The fence meets Title 22 Regulations. In addition, LPAs observed pool gate was locked with a key lock. Pool is off limit area. Also LPAs observed two windows in the detached garage that leads to the pool are locked and have working alarm on it. LPAs checked the alarm during this inspection and windows alarm are working.

The children use the living room, dining room, kitchen, converted garage (limited activity space), 1 bathroom inside the home, 1 bathroom in converted garage and front part of backyard (fenced). Per licensee, parents enter the facility through the main entrance. Per licensee, areas off limits to children and parents include: 3 bedrooms, 1 bathroom in the master bedroom, attic, laundry room, front yard, and back of back yard and pool area in the back yard. Family members residing in the home are 3 adults, licensee and her daughter have clearances on file, licensee's son turn 18 year old in October 2019 and does not have clearance on file.
REPORT CONTINUES ON 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: 01/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020
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 5
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: ADAMYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020183
VISIT DATE: 01/09/2020
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Per licensee, detached converted garage is being used only and only for limited activity. Per licensee, children eat either outside or inside the home and sleep inside the home. Per licensee, children use the detached converted garage daily from 9:00 am to 11:30 am and 3:00 pm to 5:00pm. LPAs obtained a written declaration from licensee during this inspection. LPAs observed children's bedding inside the home during this inspection.

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.



Per licensee, there are no pets, weapons, firearms 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 06/04/19, 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 has proof of current pediatric first aid and CPR (expires: 04/2021). Licensee and her assistant completed required mandated reporter training in 01/2020.

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.
REPORT CONTINUES ON 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: 01/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: ADAMYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020183
VISIT DATE: 01/09/2020
NARRATIVE
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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.

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, 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
REPORT CONTINUES ON 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: 01/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: ADAMYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020183
VISIT DATE: 01/09/2020
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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 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.

Upon receipt of this report, the Licensee shall post the Notice of Site visit and any licensing report documenting a type “A” deficiency. The report and the Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this inspection.

Exit interview was conducted with Licensee, Anna Adamyan. 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 4 of 4

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

DATE: 01/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: ADAMYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020183
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/10/2020
Section Cited

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Criminal Record Clearance
All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:(1) Obtain a California clearance or a criminal record exemption as required by the Department
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This requirement has not been met as evidence by LPAs. During this inspection licensee's son, Arman Khurshudyan, DOB: 10/20/2001 was present in the home and does not have criminal record clearance on file. This poses an immediate risk to the health and safety of children in care. $500 Civil Penalty was assessed.
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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: 01/09/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2020
LIC809 (FAS) - (06/04)
Page: 5 of 5