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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700675
Report Date: 01/24/2025
Date Signed: 01/24/2025 02:15:20 PM

Document Has Been Signed on 01/24/2025 02:15 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 CAREFACILITY NUMBER:
197700675
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
01/24/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Annelise Villa conducted a Capacity Increase inspection. Upon arrival, LPA met with licensee Oksanna Sargsyan. The requested capacity is 14. The fire department has granted a fire clearance. Licensee is advised that as a family childcare home operating at full capacity, she must adhere to the following: Operate with a Maximum of 14 children in care with no more than 2 Infants, also must have 3 school age children enrolled. Or Max. 12 Capacity with no more than 4 infants. A Qualified Assistant must be present when more than 8 children are in care.

Upon arrival, LPA observed 3 children in care. The family members residing in the home are Licensee, Licensee’s husband, Licensees mother in law and 2 minor children. Licensee presented evidence of property control. LPA confirmed with Licensee that all adults residing and working in the home have criminal record/TB clearances. The facility operates Monday through Friday from 7:00 am to 11:00 pm with a license capacity of 14 children. LPA went over the childcare ratios for a large family home with Licensee and provided Licensee a copy.

Physical Plant: This is a two story 4 bedrooms, 3 bathrooms home with kitchen, family room, living room, daycare area, front/back yards, laundry room, and attached garage. There is an operational smoke alarm and fire extinguisher maintained in the home. The home has electrical outlet covers throughout and maintains a First Aid Kit. There are adequate age appropriate toys, books, games, and napping mats/hygienic diaper changing equipment. The outdoor play area is a fenced yard, which is free of hazards and has sufficient toys. Per Licensee, there is no smoking on the premises as stated by Licensee.

Bathroom: Children use bathroom #1 is located in the hallway. The toilet and sink are in operable condition. Bathroom #1 is a half bathroom with no shower and no tub. Bathtub and shower are free of hazards. The following are inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish. Toilet and faucet are clean and operable.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2025
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: 01/24/2025
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Kitchen: The home has a clean and fully stocked clean refrigerator/freezer. Breakfast, lunch, dinner, and snacks are be provided. Licensee is advised food brought from the children’s home shall be properly stored, labeled, and dated. Licensee is not a participant in a food program.

Outdoor: Children play in the side yard. The inaccessible portion is barricaded with a wooden fence separating the side yard from the back yard. LPA observed the back yard to be accessible through the side gate of the home. The play area is clear and clean of debris, play area is fenced and gated all around, play yard has grass and cement for play time. LPA observed the side of the front to be barricaded by a self latch gate. LPA observed age appropriate toys for children.

Pools/Spas/Bodies of Water: There is a swimming pool and spa combination in the backyard. The bodies of water are completely enclosed by a 6 ft metal fence. The fence runs all the way down to the concrete on which it sits, leaving minimal room between the bottom of the fence and the concrete. The pool gate was tested and observed to have a locking mechanism. The gate has a perma-lock mechanism and it is located within 6 inches from the top of the gate. The lever to open the gate is located at the top of the gate. The pool gate opens away from the body of water. All items rendering the fence climbable are moved away from the fence. The mesh fencing is sturdy and capable of withstanding the impact of children's toys including bicycles. LPA discussed the following AB 2866 pool safety regulations with Licensee:
1. An access gate that opens away from the pool and is self-closing with a self-latching, lockable device that is no lower than 60 inches above the ground.
2. The enclosure must be at least 60 inches tall and the vertical clearance from the bottom of the enclosure to the ground must be no more than 2 inches.
3. No gaps in the enclosure that could allow for a sphere of 4 inches or larger to pass through.
4. The outside surface must be free of any physical characteristics that could be used as a handhold or foothold for a child to climb over.
5. If mesh fencing is used and it does not meet the requirements above, the licensee must provide documentation that establishes the mesh fencing is compliant with the American Society for Testing and Materials (ASTM) International Standard F2286.
6. If mesh fencing is used and it does not meet the requirements above, the licensee must provide documentation that establishes the mesh fencing is compliant with the American Society for Testing and Materials (ASTM) International Standard F2286.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
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: 01/24/2025
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Safety equipment that must be visible from the pool and available for immediate use includes:

1. A life ring with a diameter of at least 17 inches with a United States Coast Guard approval label.

2. A rescue pole with a body hook that is at least 12 feet long but must be long enough to effectively rescue a child at the facility’s pool. It must be a fixed length – and not an adjustable pole. Additional guidance will be forthcoming in written directives to specify this requirement so that the pole must be long enough for a rescue at the facility’s pool. A wider pool may require a longer rescue pole.


3. The licensee must perform a daily inspection of all above safety features before children arrive for the day. A log of the daily inspections must be maintained by the licensee and provided to the Department upon request.

Advisory/Other: First Aid kit was observed with supplies (thermometer) readily available. Licensee has a valid CPR/First Aid certification, and Mandated Reporter is maintained current. Licensee is reminded First Aid/CPR and Mandated Reporter must be renewed every two years. Review of records to be maintained: LPA reviewed with licensee the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

Documents Provided and/or Discussed: Fire Drill Log, Roster, Postings, Safe Sleep PIN 20-24-CCP, Individual Sleeping Plan (LIC9227), Large Child Care Ratio Packet, and Lead Poisoning flyer's.

The following were observed/discussed and or provided: Seat Belt Safety, Safe Sleep poster observed, forms required for children file (LIC311D), Notification of Parents' Rights (PUB394), Roster (LIC9040), License, Staffing and Ratio (capacity limitations handout provided), Emergency and Disaster Information (LIC610A, LIC9148), Lead Flyer Requirement, liability insurance (LIC282) must have signed form on file if no liability insurance. Names of all adults living in the home: All adults living/residing in the home are fingerprint cleared and associated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
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: 01/24/2025
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The smoke detector and carbon monoxide detector are in operable condition. LPA observed the required fire extinguisher (2A10BC) is fully charged. The facility sketch is complete and current, there is working telephone (cell phone). Safe and age appropriate toys, play equipment and materials were observed. Electrical outlets are inaccessible. LPA reminded licensee, no baby bouncer saucer chairs, or any recalled and or prohibited toys or sleep/play equipment are allowed on the premises. There is age appropriate napping (cots) equipment. There are no window cords (tied high) accessible to children.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed - related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Licensee advised of the requirement to report Unusual Incidents. Licensee informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (email address on the website: www.unusualincidentreport@dss.ca.gov. 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.

Prior to making alterations or additions to a family child care home or grounds, the Licensee shall notify the Department of the proposed changed, including, but not limited to, the following: Conversion of a garage (either attached or detached) into a "child care" room; Room additions to the family child care home. Any change from an area of the family childcare home previously identified as "off limits" to an area where care and supervision will be provided to children in care. Licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition or construction.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: 01/24/2025
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LPA discussed the safe sleep regulations with licensee's and also instructed Licensee to visit 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 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.

If you have questions regarding this PIN, please contact CPMB at 888-422-5669 or Guardian@dss.ca.gov for assistance.

The Department will convey all new information through PINs. Please sign up to be notified here and visit the Department’s website for the latest PINs.

Ready for licensure for large childcare license.

Exit interview conducted and report was reviewed with Licensee. This report was read and provided to Licensee on this date. Notice of Site Visit: A notice of site visit was given and must remain posted for 30 days. Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
LIC809 (FAS) - (06/04)
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