197700675-3-9-2023-12-CC-AALH-CPS5S9-20230309191220

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700675
Report Date: 03/09/2023
Date Signed: 03/09/2023 07:12:57 PM

Document Has Been Signed on 03/09/2023 07:12 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:	SARGSYAN FAMILY CHILD CARE		FACILITY NUMBER:	197700675
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS:	DATE:	03/09/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	04:54 PM
MET WITH:			TIME COMPLETED:	07:20 PM

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On 03/09/23 Licensing Program Analyst (LPA) Andrew Alemoh conducted a Pre-licensing Inspection with Applicant Oksanna Sargysan , who guided LPA on a tour of the facility. There is a pool on the premises.

This is a two-story house with 4 bedrooms, 3 bathrooms, (playroom area), family room, kitchen, laundry room area and garage. There is also a backyard. Family members residing in the home include 3 adults (Applicant and Applicant's husband, applicant mother-in-law) and two minor children.

The facility will operate Monday through Thursday from 7:00AM-6:00PM for less than 24 hours and with a license capacity of 8 children. LPA went over the child care ratios for a small family home with applicant, and provided applicant a copy.

Main care will be provided in the playroom area. Children will eat in the living room area. 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, all bedrooms, entire upstairs (barricaded by safety gate), laundry room, kitchen, and garage area are off limits to the day care children.

LPA observed day care area to be clean and orderly, fireplace screened in family room, central air and heating, age appropriate toys and play equipment, working smoke detector and carbon monoxide detector were observed.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

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: SARGSYAN FAMILY CHILD CARE	FACILITY NUMBER: 197700675
	VISIT DATE: 03/09/2023

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LPA did not observe any hazardous items in the child care 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.

LPAs observe a fully charge 2A10BC fire extinguisher during the inspection located in the kitchen area. The home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are in the garage and the off limits upstairs. First aid kit is stored in the top kitchen cabinet. LPA observed the medications to be stored in the top kitchen cabinet. All kitchen drawers are safety latched.

Kitchen: There is a baby gate making the kitchen inaccessible to children. The following are inaccessible: Sharp items are stored in the kitchen cabinet with a safety latch making it inaccessible to children in care. LPA observed the refrigerator and freezer to be clean. LPA reminded applicant, sharp utensils, open bottles or alcohol must remain inaccessible. If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. Applicant does plan to have a food program in the near future. Breakfast, lunch, snacks and dinner are provided.

LPA toured the backyard and observe it to be free of garden tools, poisonous plants, thorn trees cactus, or lawn mower inaccessible to children. There is a pool on the premises with a jacuzzi. There is black mesh fence barricaded the entire pool. LPA did measure the fence and the result came back to 4ft in height, with no lock. LPA advised licensee to put a new fence to abide by regulations. The backyard is barricaded by block cement. LPA observed the AC unit to be fully barricaded by a white fence. LPA observed applicant put the BBQ p away in the garage. LPA observed 4 dogs on the premises all in there own cages. Per licensee the dogs will not come in contact with children.

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.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

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: SARGSYAN FAMILY CHILD CARE	FACILITY NUMBER: 197700675
	VISIT DATE: 03/09/2023

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Advisory/Other: LPA observed a first Aid kit with emergency supplies and a thermometer in the top kitchen cabinet. Applicant First Aid/CPR are current. Preventative Health & Safety training is completed. Electrical outlets are inaccessible to children. Children will nap on cots/cribs in the play room 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. LPA 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.

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.

Documents Provided and or Discussed: The following were provided to comply with Title 22 requirements: Fire Drill Log, roster, Safe Sleep PIN 20-24-CCP, Individual Sleeping Plan LIC 9227, water lead poster, 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

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

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

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: SARGSYAN FAMILY CHILD CARE	FACILITY NUMBER: 197700675
	VISIT DATE: 03/09/2023

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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

LPA is currently waiting for:

1. Pool Gate Fence w/ a lock .

Exit interview conducted 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: 03/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

LIC809 (FAS) - (06/04)

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