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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001664
Report Date: 01/27/2020
Date Signed: 01/27/2020 02:03:46 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:KAZARYAN, MARINEFACILITY NUMBER:
384001664
ADMINISTRATOR:KAZARYAN, MARINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 387-8301
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94121
CAPACITY:14CENSUS: 10DATE:
01/27/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Marine KazaryanTIME COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA) Mok conducted an unannounced increased inspection today. LPA met with the licensee, Marine Kazaryan and a helper who has fingerprint clearance. The purpose of the inspection was explained. There were 10 children that included a licensee's child with a helper present. The licensee owns this 2 story single family house. Licensee lives in the house with her husband, 3 children (a daughter and 2 sons), and one of her helpers. Per licensee, her daughter studies in another city, so she comes home for visit whenever she is on break. The operation hours of the facility are Monday to Friday from 8:00AM to 6:00PM. The daycare areas are the entire lower level, deck, and backyard except the garage. The off-limit areas are the entire upper level and the garage. LPA toured and inspected the facility for health and safety hazard. The facility was clean and in order. Temperature and lighting were adequate. All toxins and harmful objects were either locked or made inaccessible to the children. All the lower kitchen cabinets were either latched or free of harmful objects. All electrical outlets were covered. Child proof knobs were installed to the all the doors to prevent children access to the off-limit areas. There were plenty of the age-appropriate toys, books, learning material & equipment, and children's furniture available. Cubbies were available for children to store their own belonging by the main entrance. There were a fully charged 2A10BC fire extinguisher, working cellular phone, working smoke and carbon monoxide detectors and first aid supplies available in the daycare areas. Carpet was installed to the daycare floor to prevent injury. The children's bathroom was clean and in order. The lower bathroom cabinet was latched. The facility provides breakfast, AM/PM snacks, lunch and dinner to the children. The outdoor play areas were completely fenced. Licensee uses the deck and backyard for the daycare. LPA inspected the yard and deck. There were some outdoor toys, playhouse, & ride-on-toys available for the children. Turf was installed into the yard as the soft cushioning to prevent injury, Per licensee, the fire drill is conducted every 3 months. The latest fire drill was conducted on 12/19/19. Licensee had current CPR/First aid training certificate for review during the inspection. The certificate will be expired on 2/9/2020. Per licensee, there were no guns, no weapons and no pets at home. Per licensee, there were no children on special 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 facilities and the ADA, available at: http://www.ada.gov/childqanda.htm. All required postings were posted. Children files were reviewed during the inspection.

This report and notice of site visit were discussed with the licensee and must be made available to the public upon request. For quarterly update on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2020
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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