434413359-8-25-2021-07-CC-JCRZ-C68UM2-20210825154138

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413359
Report Date: 08/25/2021
Date Signed: 08/25/2021 03:41:44 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:	DATE:	08/25/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:05 PM
MET WITH:	Aida Gaboian		TIME COMPLETED:	04:00 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) Janette Cruz and Mel Matos met with Aida Gaboian, Licensee, for unannounced Required – 1 year annual inspection (KIT 2). LPAs were granted access to the home by the Licensee. LPAs also observed eight day care children 8 preschool), one adult assistant, Armine Charekian, in the home during today's inspection. The Licensee was operating within her capacity and ratio requirements. LPAs observed the required postings, including the facility license, near play area of the home. Days and hours of operation are Monday - Friday from 8:00 AM to 6:00 PM. The Licensee is the only adult residing in the home. LPAs reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on August 24, 2021. The Licensee has the required vaccinations (MMR, Tdap, & flu - opt out) and is current with her Mandated Reporter Training for Child Care Workers (expiration: 05/28/23). Licensee's adult assistant has current Mandated Reporter Training for Child Care Workers (expiration: 06/10/2023). Licensee's CPR and First Aid certifications are current but are not EMSA approved. The Licensee states that she will enroll in another CPR/First Aid course through the American Red Cross and send proof to LPA Cruz. Safe sleep update: LPAs discussed the new “Safe Sleep” regulations with the Licensee and provided a copy of the regulations, including the Individual Infant Sleeping Plan (LIC 9227) form to the Licensee. LPAs reminded the Licensee that infants up to 12 months of age must sleep on their backs, shall be supervised while they are sleeping, and documentation of sleep checks must be kept in each infant’s file. Infants shall not be swaddled. There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. Cribs or play yards shall be free of loose articles and objects. LPAs toured the indoor and outdoor areas of the home during today's inspection. The Licensee has a working telephone in the home. LPAs observed sufficient materials, toys, and play equipment for the day care children.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette Cruz	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

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 2

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: 08/25/2021

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
26
27
28
29
30
31
32

LPAs observed the home is clean and orderly with heating and ventilation for safety and comfort. LPAs did not observe any wall heaters inside the home. LPAs observed that the stairs are barricaded and fireplace unit is screened in the home. Off limit areas in the home: entire second floor (2 bedrooms, 1 bathroom) and attached garage. Off limit areas outside the home: left side section of the yard and barricaded air conditioner unit.

LPAs observed a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detectors, no bodies of water, and fenced backyard. The Licensee states that she does not have pets or any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Any poisons are locked and inaccessible to the day care children. The Licensee states that she does not administer any medication to the day care children at this time.

A review of staff records on August 25, 2021 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPAs also reminded the 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 and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time without at least two full qualified adults present in the home. The Licensee states that does not transport any day care children. The Licensee understands that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

LPAs conducted an exit interview with the Licensee and advised her that no deficiencies issued during today's inspection. Licensee agreed to have the following items submitted to LPA Cruz by September 25, 2021.
1) Provide proof of enrollment and completion of CPR and First Aid renewal course.
A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette Cruz	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2