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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700233
Report Date: 03/27/2024
Date Signed: 03/27/2024 01:01:52 PM

Document Has Been Signed on 03/27/2024 01:01 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:HOVSEPYAN FAMILY CHILD CAREFACILITY NUMBER:
197700233
ADMINISTRATOR:HOVSEPYAN, HEGHINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 317-1281
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
03/27/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee Heghine HovsepyanTIME COMPLETED:
01:20 PM
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On 3/27/2024 at 9:00am, Licensing Program Analyst (LPA) Andrea Pittman conducted an unannounced annual inspection. The LPA disclosed the purpose of the inspection and was permitted entry by the Licensee. The Licensee guided the LPA on a tour of the home according to the facility sketch. Upon entry to the facility, the LPA observed 7 children in care and one staff providing care and supervision (fingerprint cleared and associated to the center.)

The operational childcare hours are Monday through Friday, 6:00am to 6:00pm; ages 0 to 13 years old.

This is a two-story family home. There is a living room, family room, classroom, kitchen, four bedrooms, three bathrooms, laundry area, and attached garage but not accessible from inside the home. The off-limits areas are the three upstairs bedrooms, two bathrooms, laundry area, and garage. Licensee does provide napping, there was one crib and 13 cots; Licensee was provided technical assistance on the Safe Sleep Policy. At 9:46am, LPA observed there was a blanket and a decoration wrapped through the bars of the crib; the Licensee states that the infant hasn’t started attendance yet, the Licensee removed the blanket and decoration, this is a technical violation. Licensee provides breakfast, lunch, dinner, and snacks; per the Licensee, children do not bring food from home but the Licensee was provided technical assistance and made aware if food is brought, then it has to be properly labeled and placed in a refrigerator. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. Hanging window blind cords: LPA did not observe any blinds on the windows in the accessible child care areas. Pets: there are two pets on premises: one cat and one dog, the Licensee states they are both fully vaccinated, LPA observed the vaccinations for the cat only. Phone service: There is a working cell phone, charged and kept on Licensee at all times.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE: DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: HOVSEPYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700233
VISIT DATE: 03/27/2024
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 Transportation: The Licensee does provide transportation for children; the Licensee is aware they must maintain a valid driver license, vehicle registration, and vehicle insurance at all times. Isolation occurs in the far corner of the classroom, in the family room, or the first bedroom for children in care showing signs of illness. The calming area is located in the far corner of the classroom or the kitchen. There is a fireplace that is screened and locked and inaccessible to children in care.

Licensee was made aware that Licensee fees are due by 5/17/2024.

Knives are kept in the kitchen in a drawer secured with a safety tab inside the drawer, inaccessible to children in care. Medication is kept in the laundry room on a high shelf secured with a safety tab, inaccessible to children in care. Cleaning supplies and chemicals are kept under the kitchen sink secured with a safety tab inside the cabinet, in the garage secured with a safety knob, and in the laundry room secured with a safety knob and inaccessible to children in care.

There are age-appropriate toys and equipment on the premises. The outdoor area is free from sharp objects, broken toys/furniture & equipment, and other debris. At 9:31am, the LPA observed the barbecue pit uncovered, the tool shed unlocked, and the external garage door unlocked; per the Licensee, the children have not been in the outdoor area due to the temperatures and have engaged in indoor play. The Licensee was provided technical assistance about inaccessibility of those areas and the Licensee corrected it during the visit. There is a decorative fountain in the backyard, the Licensee completed a LIC 855 Declaration stating that herself and staff will ensure children will not have access to the fountain during outdoor play. Per the Licensee, there are no weapons, firearms, and ammunition in the facility. The LPA did not observe any weapons, firearms, or ammunition. Per the Licensee, there is no smoking on the premises.

The First Aid kit included a temperature thermometer, tweezer, scissors, gauzes, adhesive tape, and cleansing pads/solution was observed to be complete and inaccessible to children kept in a cabinet under the bathroom sink secured by a safety tab. The required fire extinguisher (2A10BC) is reading in green. Smoke and carbon monoxide detectors were found to be in operable condition, tested at 10:02am for both detectors. Fire and Disaster drills are conducted at least every six-month, last drills were recorded on 3/25/2024 at 11:15am.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024
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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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: HOVSEPYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700233
VISIT DATE: 03/27/2024
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Licensee had all the required posted documents: Facility License (LIC 203), Notice of Parent's Rights Poster (PUB 394), Emergency Disaster Plan (LIC 610A), and Earthquake Preparedness Checklist (LIC 9148); however, the PUB 269 Child Passenger Safety Law and PUB 515 Risks & Effects of Lead Exposure were not posted, LPA provided the documents and the Licensee posted the documents.

Licensee does not have insurance on the family child care home and has the parents complete the LIC 282-Affidavit Regarding Liability Insurance for Family Child Care Homes.

The Licensee provided proof of immunization against pertussis (TDAP), measles (MMR), TB, and Influenza statement declining the Influenza shot for herself.



Licensee was able to provide a valid Pediatric CPR/First Aid training expiring in 1/2025; however, did not have proof for Staff 1 and 2, this is a Type B violation, see the LIC 809D for the details. Child Care Provider Mandated Reporter Training Certificate has been completed for the Licensee and expiring in 11/2024; however, the Licensee did not have proof for Staff 1 and 2, this is a Type B violation, see the LIC 809D for the details. Staff Personnel files were complete with the: LIC 9052-Notice of Employee Rights, background clearances, and the LIC 9108-Statement Acknowledging Requirement to Report Child Abuse. The Licensee does not have the following immunizations proof for the following staff: Staff 1 is missing the MMR and DTap vaccines/proof of immunity and TB and Staff 2 is missing the MMR and DTap vaccines/proof of immunity.

Children’s records: files were found to include the following required documents: LIC 700-Identification and Emergency Consent, LIC 627-Consent for Medical Treatment, LIC 995A-Notification of Parent’s Rights, LIC 995E-Caregiver Background Check Process, and LIC 9150- Parent Notification of Additional Children in Care, LIC 9212-Family Child Care Consumer Awareness Information; however, the Licensee was missing the School Enrollment Forms and PM 286-California School Immunization Record for the children not enrolled in school; this is a Type B violation, see the LIC 809D for the details.

Licensee's facility child roster is current and maintained up to date.

The following were discussed: No smoking, infant walkers, Johnny jumpers, exersaucers and any other item that falls into that category which are not permitted in the facility. The LPA also discussed earthquake safety and necessity of drills, required forms for children’s files, facility files, posting requirements, and penalties.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024
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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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: HOVSEPYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700233
VISIT DATE: 03/27/2024
NARRATIVE
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Facility Representative was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

The Licensee was reminded to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The Licensee was informed to utilize the Unusual Incident Report/Injury Report Form LIC624B when submitting the report to the department.

LPA discussed the safe sleep regulations with the Facility Representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/
safe-sleep as an additional resource. LPA also informed the Facility Representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicants must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-


CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the
Department. The following information regarding ADA was provided:
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024
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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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: HOVSEPYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700233
VISIT DATE: 03/27/2024
NARRATIVE
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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: https://www.ada.gov/resources/child-care-centers/.

Facility Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and the RSO profile has been completed in FAS.

Child Care Advocates:
To sign up for our Quarterly Updates, please email the Child Care Advocates at
chilcareadvocatesprogram@dss.ca.gov & call at (916) 654-1541.

The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000.

Per Title 22 Regulations, this facility is not in compliance, six Type B Deficiencies have been cited. Please, see the LIC 809D for the citations.

An exit interview was conducted, a copy of this Report, a Notice of Site visit, and Appeal rights were provided and discussed with the Facility Representative.

All licensing reports are recommended to be kept for 3 years. The Notice of Site visit is to be posted and visible to parents for 30 days.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024
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Document Has Been Signed on 03/27/2024 01:01 PM - It Cannot Be Edited


Created By: Andrea Pittman On 03/27/2024 at 12:29 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: HOVSEPYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700233

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above by not having Staff 1 and 2 complete their training which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/10/2024
Plan of Correction
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Licensee plans to e-mail the completed certificates no later than 4/10/2024.
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above by not having the proof of vaccination/immunity for DTP, MMR, & TB for Staff 1 and DTP & MMR for Staff 2 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/24/2024
Plan of Correction
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2
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Licensee plans to fax proof of vaccines/immunity no later than 4/24/2024
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mariela Ramon
LICENSING EVALUATOR NAME:Andrea Pittman
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2024


LIC809 (FAS) - (06/04)
Page: 6 of 9
Document Has Been Signed on 03/27/2024 01:01 PM - It Cannot Be Edited


Created By: Andrea Pittman On 03/27/2024 at 12:29 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: HOVSEPYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700233

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above by not having Staff 1 and Staff 2 complete their Pediatric CPR Training which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/24/2024
Plan of Correction
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Licensee plans to provide the certifications by fax no later than 4/24/2024
Type B
Section Cited
CCR
102418(g)(1)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. (1) This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required immunizations after enrollment in the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above by not having completed the PM 286 for the 11 children enrolled in care not attending school which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/10/2024
Plan of Correction
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2
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Licensee plans to provide the PM 286 for the 11 children not enrolled in school no later than 4/10/2024
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mariela Ramon
LICENSING EVALUATOR NAME:Andrea Pittman
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/27/2024 01:01 PM - It Cannot Be Edited


Created By: Andrea Pittman On 03/27/2024 at 12:29 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: HOVSEPYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700233

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102421(c)
Child's Records
(c) In any case in which the licensee cares for an additional child pursuant to Section 102416.5(b) for a Small Family Child Care Home or Section 102416.5(d) for a Large Family Child Care Home, the licensee shall maintain, in the child’s record, a copy of documentation verifying the child’s enrollment and attendance at kindergarten, including transitional kindergarten, or elementary school as required in Section 102416.5(g).

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above by not acquiring the school enrollment/attendance records for the one school age child attending the facility which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/10/2024
Plan of Correction
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2
3
4
Licensee plans to fax the school enrollment/attendance records for the one school age child no later than 4/10/2024
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above by not completing the LIC 9227 at enrollment for the two infants enrolled at the facilitywhich poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/10/2024
Plan of Correction
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2
3
4
Licensee plans to fax the completed LIC 9227 for the two infant children in care no later than 4/10/2024.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mariela Ramon
LICENSING EVALUATOR NAME:Andrea Pittman
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2024


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