197700685-3-8-2023-12-CC-AVIA-CPQQHR-20230308111133

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700685
Report Date: 03/08/2023
Date Signed: 03/08/2023 11:12:54 AM

Document Has Been Signed on 03/08/2023 11:12 AM - 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:	AYVAZYAN FAMILY CHILD CARE		FACILITY NUMBER:	197700685
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS:	DATE:	03/08/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Gohar Ayvazyan		TIME COMPLETED:	11:30 AM

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On March 8, 2023, Program Analyst (LPA) Annelise Villa conducted an announced comprehensive pre-licensing site visit due to a change of location. This visit is to ensure the home meets the health and safety standards as required by regulations governing family child care homes. LPA met with applicant for the inspection. Other residents of the home include applicant’s husband and 3 minor children. Applicant presented evidence of property control. LPA confirmed with applicant that all adults residing in the home have criminal record/TB clearances. Applicant provided evidence of completing Preventative Health training and has a Pediatric First Aid/CPR certificate which is valid thru March 2024.

This one story, 4 bed, 3 bath home was toured; the following areas are used for daycare: living room, bedroom #1, and front yard. Off limit areas include: bedrooms #2-4, bathroom #2-3, kitchen, dining room, and back yard. Drawers and lower cabinets in kitchen/bathroom are either latched or do not contain any hazardous items. 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 in the living room. The fireplace has a metal gate preventing access and fireplace tools have been removed. There are adequate age appropriate toys, books, games, and napping mats/hygienic diaper changing equipment. There are no firearms present on the premises as stated by applicant. Furthermore, there are no bodies of water. The outdoor play area is a fenced yard, which is free of hazards and has sufficient toys.

The facility will operate Monday through Friday providing 8:00 am to 6:00 pm. with no overnight care and with a license capacity of 8 children. LPA went over the childcare ratios for a small family home with applicant and provided applicant a copy.

Continued on LIC 809-C

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023

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: AYVAZYAN FAMILY CHILD CARE	FACILITY NUMBER: 197700685
	VISIT DATE: 03/08/2023

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Main care will be provided in the living room area. Children will eat in the living room area. The day care children will utilize the bathroom inside bedroom #1. Children will use the front yard for outdoor play.

LPA observed day care area to be clean and orderly, central air and heating, age-appropriate toys and play equipment, working smoke and carbon monoxide detectors are in operable condition.

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 observed a fully charge 2A10BC fire extinguisher during the inspection located in the living room near entrance door. Per applicant no alcohol is present in the home. First aid kit is also stored in the living room. Per applicant medications in the home are stored in an upper kitchen cabinet inaccessible to children in care. Cleaning items are inaccessible to children stored in the master bedroom which is gated and off limits to children.

Kitchen: The kitchen was observed to be clean and orderly. The following are inaccessible: Sharp items are stored in an kitchen cabinet, 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. The kitchen will be off limits to children in care and there is a safety gate in the entryway.

LPA toured the front yard and observed it to be free of garden tools, poisonous plants, thorn trees cactus, or lawn mower inaccessible to children. The front yard is gated completely by a brick wall with metal railings. LPA observed the outdoor air conditioning unit and electrical box to be completely blocked off by a metal gate and secured with a latch. Applicant stated there are no pets on the premises.

Continued on LIC 809-C

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023

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: AYVAZYAN FAMILY CHILD CARE	FACILITY NUMBER: 197700685
	VISIT DATE: 03/08/2023

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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: 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 but plans to. 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

Advisory/Other: LPA observed a first Aid kit with emergency supplies and a thermometer located in the living room. Applicant First Aid/CPR are current. Preventative Health & Safety training is completed. Electrical outlets are inaccessible to children. Children will nap on cots in the bedroom #1. Applicant is 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.

Continued on LIC 809-C

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023

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: AYVAZYAN FAMILY CHILD CARE	FACILITY NUMBER: 197700685
	VISIT DATE: 03/08/2023

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Applicant was informed smoking is prohibited. Applicant further stated 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 always charged during daycare 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

As a result of this inspection, the home does meet Title 22 Regulations. Applicant is ready for licensure as of March 8, 2023.

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

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023

LIC809 (FAS) - (06/04)

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