434413359-10-10-2019-07-CC-PHEZ-BGTUZD-20191010160123

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413359
Report Date: 10/10/2019
Date Signed: 10/10/2019 04:01:34 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	GABOIAN, AIDA		FACILITY NUMBER:	434413359
ADMINISTRATOR:	GABOIAN, AIDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 506-9794
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95136
CAPACITY:	14	CENSUS: 10	DATE:	10/10/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Aida Gaboian		TIME COMPLETED:	04:10 PM

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	Licensing Program Analysts (LPAs) Pete Hernandez, Dung Mac, and Marillou Monico conducted an unannounced annual inspection at the home today. LPAs met with Aida Gaboian, Licensee, and explained the nature of today's visit to her. Also present today was licensee's helper Armine Charekian. There were 10 preschool age day care children present at the time of LPA’s arrival. Hours are Monday - Friday from 8:00 AM to 6:00 PM. The Licensee lives in the home. LPA's toured the indoor or and outdoor areas of the home. LPAs notices a fully charged 2A10BC fire extinguisher. Fire drills are conducted every six months and logged. The Licensee has a working telephone in the home. LPA's observed sufficient materials, toys, and play equipment for the day care children. The home is orderly, and safe for the day care children. There is a functioning smoke detector, working carbon monoxide detector, barricaded fireplace, barricaded stairs, and no bodies of water. Off limit areas in the home: entire upstairs and garage. Off limit areas outside the home: left side yard. Cleaning compounds, medications, sharp objects, and other similar items are stored inaccessible to children. Licensee has current CPR and First Aid certification that is set to expire 6/8/2021. LPA's reviewed the files of two enrolled children, the files have all of the required documentation and immunizations. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 10/10/2019:

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: GABOIAN, AIDA	FACILITY NUMBER: 434413359
	VISIT DATE: 10/10/2019

NARRATIVE

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Website for resource information: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates

Licensee and helper Armine have current Mandated Reporter Certificates.

LPA also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list, childcareadvocatesprogram@dss.ca.gov

There were no Title 22 Deficiencies cited during this inspection.

LPAs conducted an exit interview with the Licensee .

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: GABOIAN, AIDA	FACILITY NUMBER: 434413359
	VISIT DATE: 10/10/2019

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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

A review of staff records today indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12- month period

Supervision of children was discussed with the Licensee. Licensee understands that she must be present in the home at least 80 percent of the hours the day care is in operation and ensure that the children are supervised at all times. The Licensee understands her capacity options. The Licensee states that she does not transport children and understands that children cannot be left in parked vehicles unattended at any time. Licensee understands that children's personal rights should not be violated; including no corporal punishment. Isolation of sick child, requirements for reporting suspected child abuse, unusual incidents/injuries, heat-related illnesses, and requirements for assistant/substitute were also discussed.

LPA informed Licensee that Licensing forms and Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov

LPA discussed with and provided Lead Safety Information (AB2370) to the Licensee.

LPA discussed and provided Safe Sleep Child Care information to the Licensee.

LPA discussed and provided Healthy Beverages in Child Care information (AB2084) to Licensee.
REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #3 - REPORT DATED 10/10/2019:

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019

LIC809 (FAS) - (06/04)

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