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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020457
Report Date: 10/22/2024
Date Signed: 10/22/2024 03:02:43 PM


Document Has Been Signed on 10/22/2024 03:02 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:GHAZARYAN FAMILY CHILD CAREFACILITY NUMBER:
198020457
ADMINISTRATOR:SHUSHANIK GHAZARYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(248) 469-2959
CITY:GLENDALESTATE: CAZIP CODE:
91203
CAPACITY:14CENSUS: 9DATE:
10/22/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Shushanik Ghazaryan, LiccenseeTIME COMPLETED:
03:10 PM
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ANNUAL INSPECTION CONDUCTED IN ARMENIAN
Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced Annual/Random inspection to the above facility on 10/22/24. LPA arrived at the facility at 12:40 PM and met with Shushanik Ghazaryan, Licensee who guided analyst on a tour of the facility. Also present during this inspection, were Sargis Kishmishyan, licensee's husband, Haykuhi Tadevosyan and Meline Tadevosian, Licensee’s Assistants. During this inspection licensee’s daughter, Anahit Kishmishyan, licensee’s daughter arrived to the facility. Per licensee, shushanik Ghazaryan facility hours are Monday to Friday from 7:30 a.m. to 5:30 p.m.. Per licensee, she provides care to children 0-12 years old.

This is a one-story home located on the first level. The home consists of 3 bedrooms, 2 restrooms, living room, kitchen, laundry room, front yard, backyard (fenced) and garage. Per licensee, parents enter the facility through the main entrance which leads to the living room. Per licensee the children use the bathroom in the hallway, living room (day care area), kitchen and front part of backyard (fenced). Per licensee areas off limits to children and parents include: Three bedrooms, 1 bathroom in the master bedroom, front yard, back of backyard, and garage. LPA did not observe stairs in the home. During this inspection individuals who reside in the home were discussed and notes on Confidential Name List (LIC811) and attached to this report.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. At 12:40 p.m., Licensee took this LPA on a tour of the home. LPA was toured through the interior starting with the living room. LPA observed electric outlets were covered in the living room, LPA observed children’s toys, chairs and tables in the living room. Posting requirements were observed to be posted in the living by the entrance door in the living room. Licensee showed LPA the fire extinguisher was purchased on 01/03/2024 as read by LPA from the receipt. LPA observed Fire Extinguisher was placed on the cabinet in the living room by the main entrance. LPA observed 9 children were having lunch in the living room. Next LPA was toured through the kitchen where LPA observed a dining table and chairs. LPA observed safety latches on the cabinets in the kitchen where licensee stores cleaning compounds and sharp items.
REPORT CONTINUES ON NEXT PAGE 1 of 4
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:
DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/22/2024
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: GHAZARYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020457
VISIT DATE: 10/22/2024
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LPA observed a safety gate by the kitchen to make the kitchen inaccessible to the children. Per licensee, children only transpass from kitchen to go to the backyard. Next LPA toured the bathroom in the hallway and did not observe any hazards. Next LPA toured 3 off-limit bedrooms and off-limit bathroom in the master bedroom and did not observe any hazards. LPA observed licensee's family members personal belongings in off-limit bedrooms. LPA observed a safety gate was installed in the hallway of bedrooms to make 2 off limit bedrooms inaccessible to the children. Licensee tested the carbon monoxide and smoke detectors in the hallway of the bedrooms. 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 front part of 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. LPA observed children play house, swing and play structure in the backyard, entire ground was covered with artificial grass. The licensee states that supervision is always provided. Areas off limit in the backyard are gates to be inaccessible to the children.

Per Licensee, Shushanik Ghazaryan at 1:20 p.m there are no pets, weapons, firearms, pools, spas, hot tubs, fish ponds, or similar bodies of water on the premises.

The licensee was observed to be operating within the licensed capacity and is not exceeding the required limitations during this inspection. During this inspection LPA observed nine children in the living room with licensee and her two assistants. All adults present have obtained a criminal record clearance on Licensing Information System (LIS). Per licensee, currently she has one assistant. 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.
REPORT CONTINUES ON NEXT PAGE 2 of 4
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
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: GHAZARYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020457
VISIT DATE: 10/22/2024
NARRATIVE
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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 expired on 01/2024. Licensee’s assistant, Meline Tadevosyan Pediatric First Aid and CPR expire on 11/2025. Licensee, Shushanik Ghazaryan is exempt from required mandated reporter training due to language barrier. There are first aid supplies available on the premises in the living room. LPA advised licensee that if a child shows signs of illness, he/she/they shall be separated from other children.

At 1:30 p.m., facility roster was reviewed and completed. Per licensee currently there are 9 children enrolled. LPA reviewed 5 children's records, including emergency information from 9 enrolled children, and all 5 reviewed files were completed. The licensee does have proof of immunization against influenza, pertussis, and measles. Licensee’s assistants, Meline Tadevosyan and Haykuhi Tadevosyan did not have proof of immunization against influenza, pertussis, and measles on file.

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 06/18/24. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted at the wall by the entrance.

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 11 reviewed files.

SAFE SLEEP: LPA discussed the safe sleep regulations with licensee, Shushanik Ghazaryan 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
REPORT CONTINUES ON NEXT PAGE 3 of 4
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
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: GHAZARYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020457
VISIT DATE: 10/22/2024
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INFANT CARE: Licensee states that she does not provide care to infants. 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.

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.

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.

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


Licensee, Shushanik Ghazaryan was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
During the exit interview, the Licensee, Shushanik Ghazaryan confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
Exit interview conducted and report was reviewed with the licensee, Shushanik Ghazaryan.
REPORT END 4 of 4
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 10/22/2024 03:02 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: GHAZARYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020457

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/22/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on licensee file review], the licensee did not comply with the section cited above and licensee did not have current pediatric first aid and cpr and it expired 01/2024 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/22/2024
Plan of Correction
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Per licensee, she will complete required pediatric first aid and cpr by plan of correction due date and a copy of certificate will be emailed to LPA.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on staff file review, the licensee did not comply with the section cited above and licensee did not have proof of immunization against influenza, pertussis and measles on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/22/2024
Plan of Correction
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Per licensee, her two assistants, Haykuhi Tadevosyan and Meline Tadevosian will have proof of immunization against measles, pertussis and influenza by plan of correction due date and copies will be submitted to LPA via email.
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) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:
DATE: 10/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/22/2024
LIC809 (FAS) - (06/04)
Page: 5 of 5