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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700620
Report Date: 02/21/2023
Date Signed: 02/21/2023 07:37:49 PM

Document Has Been Signed on 02/21/2023 07:37 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:HAIRAPETIAN FAMILY CHILD CAREFACILITY NUMBER:
197700620
ADMINISTRATOR:JENIK HAIRAPETIANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 442-5404
CITY:TUJUNGASTATE: CAZIP CODE:
91042
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
02/21/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
05:10 PM
MET WITH:Applicant Jenik HairapetianTIME COMPLETED:
07:45 PM
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On 02/21/2023 Licensing Program Analysts (LPA) Andrew Alemoh and conducted a Pre-licensing Inspection with Applicant Jenik Hairapetian, who guided LPA on a tour of the facility.

This is a two-story house with 3 bedrooms, 3 bathrooms, day-care room, family room, dining room, kitchen, laundry room area and garage. There is also a spacious backyard. Family members residing in the home include 3 adult one minor (Applicant, applicant husband, applicant son and 1 minor daughter).

The facility will operate Monday through Friday, 7:00AM to 6:00PM. LPA went over the child care ratios for a small family home with applicant, and provided applicant a copy. There is a white gate on the left hand side of the entrance to the home that indicates the entrance of the day care.

Main care will be provided in the day care room. LPA observed a black baby gate barricading the day care room. Children will eat in the day care area. Per applicant, she will be utilizing a food program. The day care children will utilize the hallway bathroom on the left hand side. Children will use rear yard for outdoor play. The front yard, kitchen, all upstairs bedrooms, bathrooms , laundry room, right side of the backyard and garage area are off limits to the day care children.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: HAIRAPETIAN FAMILY CHILD CARE
FACILITY NUMBER: 197700620
VISIT DATE: 02/21/2023
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Applicant was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within 24 hours of incident by telephone and in writing within 7 day of incident to the department. Applicant was informed all suspected Child Abuse should be reported to the Child Abuse Hot-line at 1-800-540-4000. The above incident should be reported on the form LIC624B per the regulation. The form should be email to unusualincidentreport@dss.ca.gov

Advisory/Other: LPA observed a first Aid kit with emergency supplies and a thermometer in the upper kitchen cabinet in the children's bathroom. Applicants First Aid/CPR are current. Preventative Health & Safety training is completed. Electrical outlets are inaccessible to children. Children will sleep on mats in the day care area. Applicants aware no infant shall be swaddled, and car seat shall not be used for sleeping. Applicant is aware to supervise infants while they are sleeping by physically checking every 15 minutes and documenting the infant’s status. Applicant should refer to regulation 102425(J) for documentation requirement. If the infant’s Individual Infant Sleeping Plan [LIC 9227 (3/20)] does not have Section C completed, the provider shall return the infant to their back for sleeping. LPA discussed the safe sleep regulations with applicant, including Safe Sleep PIN 20-24-CCP and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAs also informed applicant 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.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: HAIRAPETIAN FAMILY CHILD CARE
FACILITY NUMBER: 197700620
VISIT DATE: 02/21/2023
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LPA observed day care area to be clean and orderly, fireplace screened and locked in the day care room, central air and heating, age appropriate toys and play equipment, working smoke detector and carbon monoxide detector.

LPA observed no shampoos or shower gel in the children bathroom. LPA reminded applicant the children's bathroom must be free of shampoos, mouthwash, medication, perfumes, razor, air freshener, nail polish and polish remover. LPA observed a clean, safe and operable toilet and faucet.

LPA observe a fully charge 2A10BC fire extinguisher during the inspection located in kitchen area. Per applicant no alcohol is present in the home. First aid kit is stored in the children bathroom. Medications are stored upstairs, in the off limits areas.

LPA observed the off limit garage area. LPA observed the laundry room to be in the off limits garage area as well. Applicant made poisons and cleaning items inaccessible to children stored in laundry room (off limits with safety latch). Day care children cannot access the laundry room by the locked door.

Kitchen: The following are inaccessible: Sharp items are stored in the upper cabinet in the dining room unreachable to children in care. LPA observed the refrigerator and freezer to be clean. LPA discuss with applicant food shall be properly stored or refrigerated in container that are labeled with child’s name when supplied by parent. Applicant stated she will be getting a food program.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: HAIRAPETIAN FAMILY CHILD CARE
FACILITY NUMBER: 197700620
VISIT DATE: 02/21/2023
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LPA toured the backyard and observe it to be free of garden tools, poisonous plants, thorn trees cactus, or lawn mower inaccessible to children. The backyard is fully barricaded with wooden fence on the left side, in the middle and on the right side is cement fence. LPA observed a baby gate on the right side of the backyard. There are safe and age appropriate toys in the backyard area.

There is also an plastic children's empty swimming pool in the backyard. Applicant stated she will be using the plastic children's small pool and fill it with sand for day care children to use. LPA reminded applicant inflatable pools shall be emptied after each use. There are no dogs on the premises. LPA observed no bodies of water on the premises.

Applicant was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Documents Provided and or Discussed: The following were provided to comply with Title 22 requirements: Roster, Safe Sleep PIN 20-24-CCP, Individual Sleeping Plan (LIC 9227) required postings and list of CCLD forms required for child file each child in care (LIC 311D). Applicant stated currently does not have childcare insurance. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: HAIRAPETIAN FAMILY CHILD CARE
FACILITY NUMBER: 197700620
VISIT DATE: 02/21/2023
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Applicant inform smoking is prohibited, applicant stated no one smokes in the home, LPA discussed Health Section 1596.846(b) and (c)–102417 (g)(10) and provided applicant with a visual copy of prohibited items. LPA did not observe prohibited items during the inspection. Per applicant no firearms are present in the home. Applicant was informed her cell phone shall be available and charged at all times during day-care hours.

Incidental Medical Services (IMS) policy was discussed, informing applicant when any IMS is provided, a plan for providing IMS must be submitted to the Department prior to providing care to a child that need IMS. The plan shall state the type of IMS the facility will be offering, stating the person providing care has been trained to provide the named IMS. The plan will also provide the steps that will be taken when IMS is provided to a child.

The following information regarding ADA was discuss and the following information 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

Applicant is ready for licensure.

Exit interview is conducted a copy of this report was provided to applicant along with notice of site visit.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023
LIC809 (FAS) - (06/04)
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