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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700498
Report Date: 11/22/2023
Date Signed: 11/22/2023 01:33:18 PM

Document Has Been Signed on 11/22/2023 01:33 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:GRIGORYAN FAMILY CHILD CAREFACILITY NUMBER:
197700498
ADMINISTRATOR:SUSANNA GRIGORYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 858-4726
CITY:SUNLANDSTATE: CAZIP CODE:
91040
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
11/22/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:51 AM
MET WITH:Susanna Grigoryan, LicenseeTIME COMPLETED:
01:00 PM
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On Wednesday, November 22, 2023, at 9:45 a.m., Licensing Program Analyst (LPA) Evelyn Garcia conducted an unannounced annual inspection during arrival LPA Garcia met with licensee Susanna Grigoryan who guided LPA Garcia on a tour of the facility. Norik Tsaturyan was availble to help with translation and Narine Tsaturine was assisting with the children.

Family members residing in the home have been discussed with licensee and are cleared. LPA observed 9 children present. LPA observed facility to be within ratio. Operating hours are Monday to Friday from 8:00 a.m. to 5:00 p.m. and care for children ages 0 to 6 years old.

This facility is a one-story home that consists of 3 bedrooms, 3 bathrooms, kitchen, living room, dining room, laundry and backyard fenced. The day care area is an attached part of the home in the back part of the home that is kept separate from the living areas of the home.

Areas off limits to children include- The entire home is off limits to the children in care, as well as storage shed and side part of the backyard which is fenced off. Areas accessible to children include daycare area located behind the home and bathroom located in the daycare room and fenced outdoor play area.

LPA Garcia inspected the facility for safety, comfort, cleanliness, ventilation and working phone (cell phone and landline). For ventilation, LPA Garcia observed central AC and the vents located on the ceiling. LPA observed the furniture, children’s materials, to be in good condition and age appropriate. LPA observed cots for the children to sleep on. The children sleep in the daycare room.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2023
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: GRIGORYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700498
VISIT DATE: 11/22/2023
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LPA Garcia observed cleaning compounds items, stored underneath the bathroom sink, and observed a child proof lock in place, making it inaccessible for children to open. Knives and sharp objects stored inside the kitchen drawer however, kitchen is not accessible to the children from the daycare home. For water drinking, licensee stated she provides bottled water as well as have filtered water. The licensee stated the facility provides a.m. snack, lunch, and p.m. snack and dinner. LPA informed licensee any food brought from the children's homes, the container shall be labeled with the child's name and properly stored or refrigerated. Licensee stated she currently does not have any children with severe food allergies nor on medication.

LPA Garcia entered the bathroom and observed the toilet, hand washing sink, hand soap and LPA observed the bottom sink cabinet closed and did not observe hazard materials and observed the restroom to be in good condition. LPA reminded licensee and personal items (ex; shampoo, toothpaste, mouthwash, or items that fall into that category) must be made inaccessible to children. The licensee removed the shampoos from the shower and placed them into the cabinet with safety lock.

LPA Garcia asked the licensee if there were any pets, poisons, firearms, weapons, or bodies of water. The licensee stated she has no pets, no poisons and no bodies of water, no firearms, and no weapons. LPA did not observe pets, poisons, firearms, weapons, nor bodies of water. The license was informed that if any poisons (ex; drano, rat poison or items that fall into that category), firearms and weapons are purchased, it is required to be locked with a key or combination lock and firearm and ammunition must be stored separately.



LPA Garcia observed the required 2A10BC fire extinguisher located in the daycare area and the valve on the green area indicating fully charged. LPA observed a carbon monoxide detector and smoke alarm located in the hallway. Licensee tested the carbon monoxide. LPA Garcia heard the sounds and are operable. LPA observed the pull down fire alarm system. LPA observed the first aid complete with band aids, gauzes, adhesive bandages, and antiseptic wipes and located in the daycare room bathroom. For ill isolation, licensee stated she utilizes a corner of the daycare room. LPA observed the last emergency drill conducted on 11/22/2023.

LPA Garcia inspected the play outdoor (backyard) area that is utilized by children for safety, comfort, and cleanliness. LPA observed the backyard to be fenced and side gates close LPA observed the play equipment to be age appropriate and in a safe condition, free of sharp, no lose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. For outdoor water drinking, children bring out their water bottles. The shed was observed to be made inaccessible to the children by keylock.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2023
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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: GRIGORYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700498
VISIT DATE: 11/22/2023
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LPA Garcia observed licensee CPR School Pediatric First Aid/ CPR certification dated 3/21/23 however, LPA Garcia did not observe the card to be EMSA approved and spoke with an instructor from CPR School who confirmed they are not EMSA approved. Health and Safety certification dated 3/15/17, and licensee has proof of immunization against Pertussis, MMR, and Influenza. Licensee has completed the Child Abuse Mandated Reporter (AB 1207) training dated 10/8/2021 and her assistant Narine Tsaturian dated 5/18/22. Licensee was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com

LPA observed the postings License, LIC 9148 Earthquake Preparedness Checklist, LIC 610A Emergency Disaster Plan, Pub 394 Notification of Parents Rights, and LIC 999 Facility sketch. LPA also reviewed children’s roster, children files including sleep logs and staff files. LPA observed the files to be complete.

The following was also discussed with the licensee:



1. Refused Entry to a Facility or Any Part of a Facility is a violation of Section 1596.852, 1596.853 or 1597.09. Regulations 101238 (g) (2), The Presence of an Excluded Individual, Fire Clearance Violations, Accessible Bodies of Water, Accessible Firearms, Ammunition or Both

2 Pediatric First Aid and CPR: American Heart Association or American Red Cross or Emergency Medical Services Authority (EMSA) approved in Pediatric First Aid and CPR must be present.

3. 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 Pediatric first aid/ CPR-adult-child- infant certification (EMSA approved), a valid criminal record clearance associated to the facility license, immunization's (MMR, TDAP, TB and Influenza or Influenza declination), AB 1207 Child Abuse Mandated Reporter Certificate.

4. A current roster of children enrolled must be available and maintained for a period of 3 years, even after children are no longer attending the facility.

5. 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
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2023
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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: GRIGORYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700498
VISIT DATE: 11/22/2023
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6. The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

7. 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.

8. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing (refer to LIC 624B). Mandated reporter requirements were reviewed and explained.

9. Fire and safety drills must be performed every six (6) months and documented for review by the Department.

10. Smoking is prohibited in the family childcare home.



11. Children and staff records must be maintained and updated as needed and be available for review by the Department.

12. Immunization Requirement: H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. The licensee and all adults working with children have proof of immunizations.

13. Inspection Authority: All adults living and working in the home shall be made of aware of the Department’s right to inspection the home, which includes, but is not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.



14. The facility license number must be on all advertisements, publications, or announcements with the intent to attract clients.

15. Isolation for Ill children: When a child is ill, he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home).

16. Liability Insurance was discussed; LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2023
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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: GRIGORYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700498
VISIT DATE: 11/22/2023
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17. Dog(s) and/or pets are recommended to be isolated from children in care.

18. No baby bouncers, no infant walkers, no Johnny jumpers, no saucer chairs, and any other item that falls into this category is not permitted in the facility.



To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Family Child Care Homes Licensee 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.

Child Care Centers and Family Child Care Homes LPA discussed the safe sleep regulations with licensee 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 licensee 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Family Child Care Homes Licensee 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.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2023
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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: GRIGORYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700498
VISIT DATE: 11/22/2023
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During the exit interview, Susanna, confirmed that there are no Registered Sex Offenders living in the facility.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted, and report was reviewed with the licensee Susanna Grigoryan.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2023
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Document Has Been Signed on 11/22/2023 01:33 PM - It Cannot Be Edited


Created By: Evelyn Garcia On 11/22/2023 at 12:19 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: GRIGORYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700498

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/22/2023

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 and record review the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/29/2023
Plan of Correction
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The licensee Susanna stated she will retake the CPR course that is EMSA approved and send a photo or copy of the card to LPA Garcia via text or email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2023


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