198020214-5-14-2019-33-CC-AALN-BC6NF8-20190514102508

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020214
Report Date: 05/14/2019
Date Signed: 05/14/2019 10:25:15 AM

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:	DOBROYAN FAMILY CHILD CARE		FACILITY NUMBER:	198020214
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 1	DATE:	05/14/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Ripsime Dobroyan		TIME COMPLETED:	10:40 AM

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	A PRELICENSING INSPECTION WAS CONDUCTED IN ENGLISH Licensing Program Analyst (LPA) Ariel Cazares conducted an announced pre-licensing inspection today. LPA met with the Applicant Ripsime Doboryan and daughter in law who guided analyst on a tour of the facility. Those residing in the home are 3 adults and 1 child. Per applicant, operating hours will be Monday-Friday, 8am-6pm. Applicant states they want to care for children 0-12 y/o. All areas identified on the facility sketch were inspected. This is a one story home which consists of 3 bedrooms, 2 full restrooms, kitchen, family/living room, yard (fenced). The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. Off limits/inaccessible to daycare children: 2 bedrooms, 1 restroom, and the laundry room. The kitchen will only be accessed when transitioning outdoors. These areas are made inaccessible through child safety knobs. Accessible to daycare children: 1 bedroom, 1 restroom, living room, and yardspace. LPA inspected the areas to be used by the daycare children. One bedroom will be used for napping and play. Mats and sleeping bags were observed in the nap room. LPA observed age-appropriate equipment in the living room. There are toys and games available. The children’s restroom located adjacent to the living room was inspected. LPA did not observe any accessible hazards and drawers are kept latched. LPA inspected the kitchen that is kept off-limits via a safety gate. LPA observed in the kitchen there is a fire extinguisher purchased on 2/2/19. First aid kit is located on top of the refrigerator. There are latches on the cabinets and drawers. There is both a functional smoke and carbon monoxide detector in the living room. Per applicant there are no weapons, firearms in the facility at this time. There are no pets in the home.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Ariel Almazan	TELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2019

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: DOBROYAN FAMILY CHILD CARE	FACILITY NUMBER: 198020214
	VISIT DATE: 05/14/2019

NARRATIVE

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·No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.
·All adults living and working in the home shall be made of aware of the Departments right to inspection authority.
·Liability insurance was discussed with applicant.
·Mandated reporter training must be taken every 2 years.

During this visit, the LPA reviewed and issued Forms/Records to Keep in Your Family Child Care Home (LIC 311D) to the applicant. LPA reviewed Sudden Infant Death Syndrome (SIDS), Shaken Baby Syndrome, and safe sleep practices with licensee. *Infants should always sleep on their backs, mouths facing up, light bedding.* Safe sleep concepts were provided to applicant, along with Spring 2019 Quarterly Updates.

LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing Website at: www.ccld.ca.gov

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

Per applicant, there are no other licenses held at this location.

Once licensed, the applicant is required to adhere to the terms and limitations as stated on the license.

Exit interview was conducted with the Applicant Ripsime Dobroyan who is in agreement with the above. A copy of this report and all other licensing reports must be made available to the public for 3 years.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Ariel Almazan	TELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2019

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: DOBROYAN FAMILY CHILD CARE	FACILITY NUMBER: 198020214
	VISIT DATE: 05/14/2019

NARRATIVE

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LPA toured the outdoor play area and inspected its safety and condition. The space is fenced and there is NO swimming pool, spa or other bodies of water observed on the premises. There are age appropriate toys and play equipment on site. There are 4 cameras on the property of the home.

The required postings were observed at the entrance of the facility. Applicant has completed the Preventative Health and Safety and First Aid/CPR course which expires on 01/2021. The mandated reporter training was completed on 03/18/19 and is on file.

The following was discussed with the applicant:

·Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
·In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification, TB clearance, and a valid criminal record clearance associated to the facility license.
·A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
·The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked and batteries replaced as needed.
·Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
·Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. Mandated reporter requirements was reviewed and explained.
·Fire and safety drills must be performed every six months and documented for review by the Department.
·Smoking is prohibited in a family child care home, 24/7.
·Children and Staff records must be maintained and updated as needed and must be available for review by the Department.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Ariel Almazan	TELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2019

LIC809 (FAS) - (06/04)

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