198020214-6-11-2020-33-CC-AEIN-BQGRFB-20200611125853

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020214
Report Date: 06/11/2020
Date Signed: 06/11/2020 12:59:01 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:	DOBROYAN FAMILY CHILD CARE		FACILITY NUMBER:	198020214
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 5	DATE:	06/11/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Ripsimie Dobroyan,Licensee		TIME COMPLETED:	01:00 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	CASE MANAGEMENT TELEVISIT (FACETIME) CONDUCTED IN ARMENIAN This was a case management televisit inspection conducted by Licensing Program Analyst (LPA) Anomeh Eivazian due to COVID-19 and precautionary measures. This case management inspection was conducted with Licensee Ripsime Dobroyan in Armenian via Facetime to address a request for a capacity increase to a Large Family Child Care Home (FCCH) license. For Large Family Child Care Home Fire Clearance was granted on 05/20/2020. This is a one story home which consists of 3 bedrooms, 2 full restrooms, kitchen, living room (play area), laundry room, front yard and side yard (fenced). The children use the living room (playroom), 1 bedroom, 1 restroom adjacent to the kitchen, and front yard (fenced). Per licensee, areas off limits to children and parents include: Kitchen, 2 bedrooms, 1 restroom, the laundry room, and side yard. The kitchen will only be accessed when transitioning outdoors. Also LPA observed a safe gate was installed to the kitchen to make it inaccessible. Per licensee parents enter the facility through the main entrance. Family members residing in the home are 4 adults who have clearances on file and 1 children. Per licensee operating hours will be Monday – Friday from 7:00 am- 6:00pm. The licensee is caring for children 0-12 years of age. During this tele-inspection the Licensee took this LPA on a tour of the home. At 12:00 pm, LPA was toured through the interior starting with the living room (playroom) and electrical outlets were observed to be covered. Next the living room LPA was toured through the kitchen, LPA observed a latch on the cabinet under the sink which stores cleaning compounds. The knives and sharp items are stored in drawers and LPA observed latches on drawers. Next LPA toured the 1 bedroom adjacent to main kitchen and living room. LPA did not observe accessible hazards. Licensee showed LPA the cabinet in the restroom is secured. REPORT CONTINUES ON NEXT PAGE 1 of 3

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2020

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: 06/11/2020

NARRATIVE

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Licensee showed LPA 1 bedroom that children use, where 5 children were observed napping and licensee's assistant, Anna Sargsyan was also present in that room. Licensee confirmed that only 5 children were in care during this inspection. LPA toured the two off limit bedrooms, 1 off-limit bathroom, laundry room, and side yard and did not observe accessible hazards. At 12:15 pm, LPA was toured through the front yard (fenced) where children play. LPA did not observe accessible/immediate hazards during the tour of the front yard.

At 12:25 pm, licensee showed LPA the fire extinguisher that was serviced 01/27/2020, as read by licensee from the service tag. LPA observed Fire Extinguisher was anchored to the wall in the kitchen. Licensee also tested the carbon monoxide detector in the kitchen and smoke detector in the living room. Both sounded off the alarms and heard by LPA to be functional.

The licensee was observed to be operating within the licensed capacity and is not exceeding the required limitations at 12:30 pm. All adults present in the home during this inspection have obtained a criminal record clearance on Licensing Information System (LIS). The licensee has proof of current pediatric first aid and CPR (expires: 01/2021). Licensee completed required mandated reporter training on 03/18/2019. Per licensee at 12:35 pm, there are no pets, weapons, firearms or bodies of water on the premises.

INFANT CARE: Licensee states at 12:37 pm, that she does care for infants. Any infants in care will stay in the area where the licensee or assistant are. LPA 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. LPA 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 at 12:40 pm. 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 2 of 3

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2020

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: 06/11/2020

NARRATIVE

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Per licensee, she does not carry liability insurance or a bond in accordance with standard established by Family Child Care statue.

LPA consulted and explained at 12:43 pm, 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

The home has no need for corrections at this time based on the televisit inspection conducted by LPA Eivazian from the areas that were inspected. LPA asked the licensee’s practices related to COVID-19. Licensee stated that she practices hygiene such as hand washing with the children. Licensee has hand sanitizer available in the drop off area and inside her home. Licensee states she practices social distancing with children. Licensee stated children change their shoes upon arrival.

Based on this information and LPA's observation, at this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

Exit interview was conducted with Licensee Ripsime Dobroyan, via tele-inspection, during which appeal rights were explained. This report along with a copy of the appeal rights and Notice of Site Visit (LIC9213) will be sent to the Licensee via email with a read receipt or confirmation of receipt of email, which will act as the Licensee’s signature.

REPORT END 3 of 3

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2020

LIC809 (FAS) - (06/04)

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