198020183-5-15-2023-33-CC-AEIN-CRUUK2-20230515153824

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020183
Report Date: 05/15/2023
Date Signed: 05/15/2023 03:38:40 PM

Document Has Been Signed on 05/15/2023 03:38 PM - It Cannot Be Edited

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 CARE		FACILITY NUMBER:	198020183
ADMINISTRATOR:	ANNA ADAMYAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 507-9068
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY:	14	CENSUS: 9	DATE:	05/15/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Anna Adamyan, Licensee		TIME COMPLETED:	03:50 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	REQUIRED- 1 YEAR INSPECTION CONDUCTED IN ARMENIAN Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced required 1- year inspection to the above facility on 05/15/23. LPA arrived at the facility at 12:50 PM and met with Anna Adamyan, Licensee who guided analyst on a tour of the facility. A COVID 19 risk assessment was conducted prior to entering the facility. Also present during this inspection, was Gayane Kirakosyan, Licensee’s Assistant. Per licensee, Anna Adamyan facility hours are Monday to Friday from 8:00 a.m. to 5:30 p.m. LPA provided a copy of Entrance Checklist—Family Child Care Home (LIC126) to licensee. 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, LPA observed pool gate was locked with a key lock. Pool is off limit area. Also LPA observed two windows in the detached garage that leads to the pool are locked and have working alarm on it. LPA checked the alarm during this inspection and windows alarm were working. Per licensee, parents enter the home through the side gate which leads to the backyard and main entrance which leads to the living room. Upon LPA's arrival to the facility at 12:50 PM LPA observed three pack n' plays in the detached converted garage and one infant was napping in the pack n' play in the detached converted garage from 12:50 PM to 2:00 PM. Per licensee, there were occasions that due to the weather and rain, children ate inside the detached converted garage, and younger children slept in the detached converted garage. REPORT CONTINUES ON NEXT PAGE 1 of 5

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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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: 05/15/2023

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During this inspection LPA contacted City of Glendale and verified the detached converted garage is not permitted through the City of Glendale. LPA informed licensee that converted garage can be only used for limited activity only and children can not eat or sleep inside the converted garage. Per licensee, effective today licensee will use the detached converted garage for limited activity only, daily from 9:30 AM to 11:30 AM and 3:00 PM to 5:00 PM. Per licensee, children will eat either outside or inside the main home and will sleep inside the main home in the living room.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. At 1:10 p.m., Licensee took this LPA on a tour of the home. LPA was toured through the interior starting with the detached converted garage, LPA observed nine children in the detached converted garage, four being infants with licensee and her assistant. LPA observed one infant was napping in the pack n'play in the detached converted garage, LPA observed total of three pack n' plays, children tables, chairs and toys in the detached converted garage. Next LPA toured the bathroom in the detached converted garage and did not observe any hazards. LPA observed all electrical outlets were covered in detached converted garage. Next LPA toured the kitchen in the main home and observed child proof safety latches on the cabinets where licensee stores sharp items and cleaning compounds. Next LPA toured the living room and dining room and observed children napping cots in the living room. LPA observed four children were taken to the living room to take nap inside the main home. Next LPA toured the one bathroom in the hallway and did not observe any hazards. LPA observed off-limit bedrooms doors were closed during this inspection. LPA observed the required 2A10BC fire extinguishers were anchored to the wall in the detached converted garage and in the kitchen. Both were serviced on 05/15/23 as read by LPA from the service tag. Licensee tested the carbon monoxide and smoke detectors in the living room and detached converted garage. Both sounded off the alarms and heard by LPA to be functional. Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock.

Next LPA toured the backyard fenced. Currently, children are using the back yard for outdoor play time. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that can pose a danger to children on the outdoor yard. The licensee states that supervision is always provided.

REPORT CONTINUES ON NEXT PAGE 2 of 5

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2023

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: ADAMYAN FAMILY CHILD CARE	FACILITY NUMBER: 198020183
	VISIT DATE: 05/15/2023

NARRATIVE

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Per Licensee, Anna Adamyan at 2:00 p.m there are no pets, weapons, and firearms the premises.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 06/23. Licensee, Anna Adamyan completed required mandated reporter training on 01/04/22. There are first aid supplies available on the premises in the detached converted garage. LPA advised licensee that if a child shows signs of illness he/she/they shall be separated from other children.

The licensee was observed to be operating within the licensed capacity and is not exceeding the required limitations during this inspection. During this inspection there were nine children present in the home, four being infants with licensee and her assistant. All adults present have obtained a criminal record clearance on Licensing Information System (LIS). Per licensee, currently she has two assistants. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

At 2:10 p.m., facility roster was reviewed and completed. Per licensee currently there are 10 children enrolled. LPA reviewed 5 children's records, including emergency information from 10 enrolled children, and all 5 reviewed files were completed.

The licensee and her assistant have proof of immunization against influenza, pertussis, and measles. 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 00/00/00. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted at the wall by the entrance in the living room.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home. There is telephone service via a cellphone that is used and the cellphone stays at the facility during operation hours. 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 5 reviewed files.

REPORT CONTINUES ON NEXT PAGE 3 of 5

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2023

LIC809 (FAS) - (06/04)

Page: 3 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: ADAMYAN FAMILY CHILD CARE	FACILITY NUMBER: 198020183
	VISIT DATE: 05/15/2023

NARRATIVE

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SAFE SLEEP: LPA discussed the safe sleep regulations with licensee, and discussed the Child Care Licensing Safe Sleep webpage at http://www.cdss.ca.gov/inforescources/child-care-licensing/public-information-and-resoucrces/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at http://www/cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. Boppy recall: https://www.cpsc.gov/Recalls/2021/The-Boppy-Company-Recalls-Over-3-Million-Original-Newborn-Loungers-Boppy-Preferred-Newborn-Loungers-and-Pottery-Barn-Kids-Boppy-Newborn-Loungers-After-8-Infant-Deaths-Suffocation-Risk
INFANT CARE: Licensee states that currently she has four infants enrolled in her daycare. Licensee states infants were sleeping in the detached converted garage but as of today they will only sleep inside the main home in the living room and dining room where they are constantly supervised. Appropriate sleeping arrangements and cribs were observed. (one crib for each infant in care was observed). Cribs or play yard did not hinder the entrance or exit from the sleeping space, mattresses shall be firm and covered with a fitted sheet that overlaps the underside so it cannot be dislodged. Cribs and play yards were observed to be free of loose articles and objects. No objects were observed to be hanging above or attached to the side of the crib. LPA did/did not observe any infants swaddled while in care. LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. A copy of the LIC 9227 was provided to Licensee. LPA provided the licensee with a copy of A Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. LPA also consulted and explained Child Abuse Reporting, Never Shake a Baby, and Safe Sleeping practices.

Medication: Incidental Medical Services (IMS) policy was discussed. The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. 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.

REPORT CONTINUES ON NEXT PAGE 4 of 5

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2023

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: ADAMYAN FAMILY CHILD CARE	FACILITY NUMBER: 198020183
	VISIT DATE: 05/15/2023

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LPA advised the licensee to access forms, regulations and quarterly updates online at: www.ccld.ca.gov.

The following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

LPA Eivazian informed licensee Anna Adamyan that this report dated 05/15/23 document(s) 1 Type A citation which shall be posted for 30 consecutive days as there is/are immediate risks to the health, safety, or personal rights of children in care.

Also, LPA Eivazian informed the licensee Anna Adamyan to provide a copy of this licensing report dated 05/15/23 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

The Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experienced. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding inspection tools and methods, please visit the Program website at www.cdss.gov/inforesouces/community-care-liceinsing/inspection-process

Exit interview conducted and report was reviewed with the Licensee, Anna Adamyan at 3:50 PM.

REPORT END 5 of 5

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2023

LIC809 (FAS) - (06/04)

Page: 5 of 6

Document Has Been Signed on 05/15/2023 03:38 PM - It Cannot Be Edited

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: 05/15/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102352(f)(1)

Definitions "Family Day Care" or "Family Child Care" means regularly provided care, protection and supervision of children, in the care giver's own home, for periods of less than 24 hours per day, while the parents or authorized representatives are away. The term "Family Child Care" supersedes the term "Family Day Care" as used in previous regulations This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA's observation on 05/15/23 at 12:50 PM, LPA observed one infant was napping from 12:50 PM to 2:00 PM in detached converted garage. Per licensee, infants were napping in the detached converted garage and there were occasions that children ate inside the detached converted garage, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 05/16/2023
	Plan of Correction
1 2 3 4	Per licensee, effective today children will eat either outside or inside the main home in the living room and will sleep inside the main home in the living room. Per licensee, children will use the detached converted garage for limited activity only daily from 9:30 AM to 11:30 AM and from 3:00 PM to 5:00 PM. LPA asked licensee to submit a written declaration to LPA to use the detached converted garage for limited activity only.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2023

LIC809 (FAS) - (06/04)

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