198020702-12-15-2020-33-CC-AEIN-BWBQMT-20201215111803

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020702
Report Date: 12/15/2020
Date Signed: 12/15/2020 11:18:24 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:	HAKOBYAN FAMILY CHILD CARE		FACILITY NUMBER:	198020702
ADMINISTRATOR:	HASMIK HAKOBYAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 471-8722
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91206
CAPACITY:	14	CENSUS: 0	DATE:	12/15/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Hasmik Hakobyan, Licensee		TIME COMPLETED:	11:30 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 at 8:30 a.m.. LPA met with Hasmik Hakobyan, Applicant who guided analyst on a tour of the facility. Family members residing in the home are 2 adults (applicant and her husband) and 0 children. During this inspection applicant's husband, Avetik Hakobyan and applicant's daughter, Nunufar Hakobyan. The applicant is requesting a small family child care home license. Per applicant operation hours will be Monday to Friday from 6:00 a.m. to 6:00 p.m. Applicant states she will care for children 0-13 years old. All areas identified on the facility sketch were inspected. This is a one story home located on the first level. The home consists of 3 bedrooms, 2 restrooms, living room (daycare area), dining room, kitchen, front yard, backyard (fenced), and garage. There is a screen door with (1) lock on the front entrance. In addition, the wrought iron railings and openings leading to front door are covered with mesh. Areas that are accessible to children are as follows: Living room (daycare room), kitchen, bedroom #1 and backyard (fenced). There is a fireplace in the living room which has been blocked off to prevent access to children. Per applicant children will only walk through the kitchen to go to the backyard. Per applicant parents will use the main entrance which leads to the living room (daycare room) and side gate which leads to the backyard to enter the facility. Areas off limits based on facility sketch submitted to children and parents include: Two bedrooms, 1 bathroom in the master bedroom, dining room, garage, front yard, and back of backyard.Rooms that are off-limits need to be made inaccessible during operating hours Per applicant at 9:43 a.m. children will use the backyard (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. 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: 12/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2020

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: HAKOBYAN FAMILY CHILD CARE	FACILITY NUMBER: 198020702
	VISIT DATE: 12/15/2020

NARRATIVE

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At 8:40 am, the applicant began touring LPA’s through the home starting with the entry way which lead directly to the living room (daycare) and electrical outlets were observed to be covered. LPA observed in the living there is a fireplace which is screened to prevent access. LPA observed children toys, tables and chairs in the living room. LPA observed applicant stores an Emergency kit in a closet in the living room (daycare room). At 8 50 am, applicant showed LPA the fire extinguisher purchased 10/2020, as read by applicant from the tag. LPA observed Fire Extinguisher was anchored to the wall in the living room by the entrance door. Next the kitchen was inspected, and LPA observed safety latches on the cabinets were applicant stores cleaning compounds and sharp items. LPA observed a safety gate was installed to the kitchen to make it inaccessible to children. Per applicant children only use the kitchen to walk through to go to the backyard. Next LPA toured the bedroom #1 and did not observe any hazards. Next LPA was toured 2 off limit bedrooms, 1 off-limit bathroom in the master bedroom, and dining room and did not observe any hazards. LPA observed applicant's and her husband's personal belongings in bedrooms. LPA observed a coffee table and sofas in bedroom #2, beds in bedrooms #1 and #3, and dining table and chairs in dining room. Next LPA toured the one bathroom in the hallway and observed safety latches on the cabinet under the sink were applicant stores cleaning compounds. Applicant also tested the carbon monoxide and smoke detractors in the hallway of bedrooms. It sounded off the alarm and heard by LPA to be functional.Next LPA toured the backyard and did not observe any hazards. LPA observed turf and cement area in the backyard. Daycare backyard area is separated from the rest of the backyard by fence. LPA toured the garage and did not observe any hazards.

The applicant states at 10:09 a.m. that she will provide food for children in care. Applicant was advised at 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 10:12 am, there are no pets, weapons, firearms or bodies of water on the premises. There are toys available for children.
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: 10/24/2020), Pediatric First Aid and CPR (ex. 10/2022).
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.
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: 12/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2020

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: HAKOBYAN FAMILY CHILD CARE	FACILITY NUMBER: 198020702
	VISIT DATE: 12/15/2020

NARRATIVE

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-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.
-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 10:20 a.m. that she does not care for infants. LPA advised the applicant to sleep infants where they can be directly supervised at all time. LPA advised the applicant to sleep infants where the infant can be directly supervised and advised against sleeping infants in a separate room. Applicant stated at 10:20 a.m infants will sleep in the living room (daycare) area and living room #1. 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: 12/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2020

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: HAKOBYAN FAMILY CHILD CARE	FACILITY NUMBER: 198020702
	VISIT DATE: 12/15/2020

NARRATIVE

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Medication: 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 dual licenses at this address. Applicant’s email address was obtained during this inspection. The applicant was advised that email may be public information. Per applicant, she does not carry liability insurance or a bond in accordance with standard established by Family Child Care statue.
The applicant has proof of immunization against influenza, pertussis, and measles. Applicant completed required mandated reporter training on 10/26/2020. Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com.
During this inspection LPA discussed PIN 20-06 CCP, Social And Physical Distancing Guidance And Healthy Practices For Child Care Facilities In Response To The Global Coronavirus (COVID-19) Pandemic Written In Collaboration With The California Department Of Education and reviewed Child Care Covid-19 Self Assessment.
LPA consulted and explained 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. 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

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. The applicant’s signature on this report acknowledges that they have signed the Application for a Family Child Care Home License (LIC 279) under the penalty of perjury that the statements on the application and any attachments are correct. Exit interview was conducted with Hasmik Hakobyan Applicant at 11:30 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: 12/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2020

LIC809 (FAS) - (06/04)

Page: 4 of 4