198020587-7-22-2020-33-CC-CGRN-BRS3Z6-20200722184101

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020587
Report Date: 07/21/2020
Date Signed: 07/22/2020 06:41:17 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:	GIESOGIAN FAMILY CHILD CARE		FACILITY NUMBER:	198020587
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	07/21/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Nazik Giesogian and Agkop Baltagian		TIME COMPLETED:	11:15 AM

NARRATIVE

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Licensing Program Analyst (LPA) Crystal Green conducted an announced pre-licensing tele-inspection at 10:30 AM via FaceTime due to COVID-19 and precautionary measures. This pre-licensing inspection was conducted with Nazik Giesogian, Applicant and Agkop Baltagian, Applicant’s son. Applicant is requesting a small Family Child Care License.

During this tele-inspection the Applicant’s son took this LPA on a tour of the home. During this tour the following was noted: All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a one-story home that consists of 3 bedrooms, 2 restrooms, living room, kitchen, dining area, garage, basement, and backyard (fenced). Per applicant, the children will use living room, 1 restroom, and backyard (fenced). Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service. During tour, LPA observed a fireplace located in the living room. The fireplace was observed to be made inaccessible via a storage shelf.

Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. The applicant was advised that any poisons must be kept locked and inaccessible to children in care.

Based on the Facility Sketch submitted, areas off limits to children and parents are: Includes the 3 bedrooms, 1 restroom, kitchen, dining area, basement, and the garage. The applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

OUTDOOR PLAY AREA

The children will use the backyard area for outdoor play. LPA observed the backyard area to be fenced. Per applicant will provide visual supervision while children are outdoors.

REPORT CONTINUES ON NEXT PAGE - 01 of 04

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 854-5730
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2020

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: GIESOGIAN FAMILY CHILD CARE	FACILITY NUMBER: 198020587
	VISIT DATE: 07/21/2020

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Per applicant, there are no pets, no firearms, or weapons on the premises. The home shall contain a fire extinguisher which meet standards established by the State Fire Marshal. LPA observed applicant to have a 2A10BC fire extinguisher purchased on 7/17/2020. Smoke and carbon monoxide detectors were tested and are operable. There are toys available for children.

The applicant states that she will provide food for children in care. The applicant has completed the required Health and Safety Training, Nutrition Training and Pediatric First Aid and CPR. Applicant has completed the required Mandated Reporter Training. There are first aid supplies available in the home.

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. Civil Penalties will be assessed if not in compliance.

· 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 Pediatric First Aid and CPR certification and a valid criminal record clearance associated to the facility license.

· Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated.

· The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

· Reporting Requirements: 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.

REPORT CONTINUES ON NEXT PAGE - 02 of 04

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 854-5730
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2020

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: GIESOGIAN FAMILY CHILD CARE	FACILITY NUMBER: 198020587
	VISIT DATE: 07/21/2020

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· 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.

· 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. Smoking on the premises is prohibited.

· 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.

· Licensees shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.

· Liability Insurance: Per applicant, she will be obtaining liability insures. LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information.

· UPDATE: H&S 1597.622: 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. The licensee and all adults working with children have proof of immunizations.

Infant Care: Applicant states that they will care for infants. LPA advises that the applicant to sleep infants where they can be directly supervised at all times and advised against sleeping infants in a separate room. LPA provided the applicant with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. Online copy can be downloaded at: https://www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf

REPORT CONTINUES ON NEXT PAGE - 03 of 04

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 854-5730
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2020

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: GIESOGIAN FAMILY CHILD CARE	FACILITY NUMBER: 198020587
	VISIT DATE: 07/21/2020

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Incidental Medical Services (IMS):

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

LPA advised the applicant how to access forms, regulations and quarterly updates 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).

This home currently meets the description of a safe and healthy environment for children as described in Chapter 1, Division 12, Title 22 of California Code of Regulations and the facility will be submitted for approval for a small family child care license.

Exit interview was conducted with Nazik Giesogian and Agkop Baltagian, via tele-inspection. This report along will be sent to the Applicant via email with a read receipt or confirmation of receipt of email, which will act as the Applicants signature.

REPORT END - PAGE 04 of 04

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 854-5730
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2020

LIC809 (FAS) - (06/04)

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