198020519-2-27-2020-33-CC-AEIN-BM7PKW-20200227102350

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020519
Report Date: 02/27/2020
Date Signed: 02/27/2020 10:23:59 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:	ANTONYAN FAMILY CHILD CARE		FACILITY NUMBER:	198020519
ADMINISTRATOR:	LILIT ANTONYAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 468-7461
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91207
CAPACITY:	14	CENSUS: 0	DATE:	02/27/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Lilit Antonyan, Applicant		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	PRELICENSING INSPECTION CONDUCTED IN ARMENIAN Licensing Program Analyst (LPA) Anomeh Eivazian conducted a pre-licensing inspection today. LPA met with Lilit Antonyan, Applicant at 8:20 a.m.. who guided analyst on a tour of the facility. Family members residing in the home are 4 adults and 0 children. The applicant is requesting a large family child care home license. Per applicant operation hours will be seven days a week, 24 hours a day, for less than 24 hours care. Applicant states at 9:25 a.m. she will care for children 0-12 years old. Applicant was previously licensed with facility number 198019641 at 232 North Adams Street, Glendale, CA 91206. For Large Family Child Care Home Fire Clearance was granted on 02/19/2020. A qualified assistant must be present and actively involved in caring for children whenever nine (9) or more children are present at the facility and a license for a large family child care home. All areas identified on the facility sketch were inspected at 8:50 a.m.. This is a one story home consists of 3 bedrooms, 2 and 1/2 restrooms, living room, dining room, kitchen, detached garage, front yard, side yard and backyard (fenced). There is a fireplace in the living room which has been blocked off to prevent access to children. Areas that are accessible to children are as follows: 1/2 Bathroom in last bedroom (day care room), one bedroom (day care room), living room, dining room, kitchen, side yard and backyard fenced. Per applicant at 9:39 a.m. parents will enter the facility through the side gate which is located on East Dryden Street and leads to the backyard and day care room. REPORT CONTINUES ON NEXT PAGE 1 of 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020

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 4

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: ANTONYAN FAMILY CHILD CARE	FACILITY NUMBER: 198020519
	VISIT DATE: 02/27/2020

NARRATIVE

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Areas off limits based on facility sketch submitted to children and parents include: Two bedrooms, 2 bathrooms, front yard, and detached garage.
**Rooms that are off-limits need to be made inaccessible during operating hours**
Per applicant at 9:34 a.m. children will use the backyard and side yard (fenced) for outdoor activity. Children will be physically and visually supervised at all times. The applicant does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.

Areas that will be used by children were inspected at 9:00 a.m. for safety, comfort, cleanliness, telephone service (land line), ventilation and heating (central). Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible. The applicant states at 9:41 a.m. that there are no poison in the home, but does understand that if any poison is purchased, it is required to be locked with a key or combination lock. Applicant was advised at 9:42 a.m.that if food is brought from the children’s homes, all containers must be labeled with child’s name and properly stored or refrigerated.

Per applicant at 9:42 a.m., there are no pets, firearms, weapons, bodies of water on the premises. There are toys available for children. The valve on the required 2A 10BC fire extinguisher indicates fully charged (purchased 02/17/2020). Smoke and carbon monoxide detector in the day care room was tested and is operable.

Applicant has proof of CPR and First Aid training as indicated on the certificate. The applicant does have proof of Health and Safety training (completion date: 06/08/2017), Pediatric First Aid and CPR (ex. 10/2020).There is emergency supplies on the premises.
The following was discussed with the applicant at 10:05 a.m.:
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 and a valid criminal record clearance associated to the facility license.
REPORT CONTINUES ON NEXT PAGE 2 of 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: ANTONYAN FAMILY CHILD CARE	FACILITY NUMBER: 198020519
	VISIT DATE: 02/27/2020

NARRATIVE

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-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.
-Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License shall be terminated.
-The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should check 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.
-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)
-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.
-Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
-Dog(s) and or pets are recommended to be isolated from children in care.
- No smoking, 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, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
- Applicant shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.
- Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.

Infant Care: Applicant states at 9:47 a.m. that she does care for infants. LPA advised the applicant at 9:48 a.m.to sleep infants where they can be directly supervised at all time. LPA advised the applicant at 10:00 a.m. to sleep infants where the infant can be directly supervised and advised against sleeping infants in a separate room. The applicant 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.

REPORT CONTINUES ON NEXT PAGE 3 of 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: ANTONYAN FAMILY CHILD CARE	FACILITY NUMBER: 198020519
	VISIT DATE: 02/27/2020

NARRATIVE

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Medication: Incidental Medical Services (IMS) policy was discussed at 9:50 a.m. 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 dual licenses at this address. Applicant’s email address was obtained during this inspection at 9:49 a.m.. The applicant was advised that email may be public information. Per applicant at 9:52 a.m., she carries liability insurance or a bond in accordance with standard established by Family Child Care statue. The applicant and her family members have proof of immunization against influenza, pertussis, and measles. Applicant completed required mandated reporter training on 01/10/2020. Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com

LPA consulted and explained at 10:10 a.m. 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.

In addition, LPA distributed at 10:15 a.m. LIC-311D and explained the following forms:
LPA advised the applicant how to access forms, regulations and quarterly updates, and Provider Information Notices (PIN) on the Child Care Licensing website at: www.ccld.ca.gov. LPA reviewed and issued the Forms/Records to Keep in Your Family Child Care Home (LIC 311D) and provided the following forms:
CHILDREN FORMS/RECORDS , FACILITY FORMS/RECORDS , INFORMATION TO BE POSTED IN YOUR FAMILY CHILD CARE HOME
The following corrections need to be corrected prior to obtaining a large family child care license. Corrections are due by 03/13/2020.
1. Applicant will add railings to the stairs in the backyard which leads to the kitchen and side yard.
A large family child care license will be granted upon receipt of proof of corrections for the above. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license. A copy of this report and all other Licensing reports must be made available to the public for 3 years.
Exit interview was conducted with Lilit Antonyan, Applicant at 10:20 a.m. who is in agreement with the above.
REPORT END 4 of 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020

LIC809 (FAS) - (06/04)

Page: 4 of 4