197700701-7-24-2024-12-CC-EGAA-D7GR25-20240724123747

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700701
Report Date: 07/24/2024
Date Signed: 07/24/2024 12:39:53 PM

Document Has Been Signed on 07/24/2024 12:39 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:	AZIZYAN FAMILY CHILD CARE		FACILITY NUMBER:	197700701
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 8	DATE:	07/24/2024
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:00 AM
MET WITH:	Nelly Azizyan, Licensee		TIME VISIT/ INSPECTION COMPLETED:	01:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On July 24, 2024, Licensing Program Analyst (LPA) Evelyn Garcia conducted a Capacity Increase inspection. Upon arrival, LPA met with licensee Nelli Azizyan. The requested capacity is 14. The fire department has granted a fire clearance on 6/7/24. Licensee is advised that as a family childcare home operating at full capacity, they must adhere to the following: Operate with a Maximum of 14 children in care with no more than 3 Infants, also must have 2 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. There are no pools or bodies of water located on premises. Upon arrival, LPA observed 8 children in care. Other residents of the home include licensee’s spouse and 2 minor children. Applicant presented evidence of property control. LPA confirmed with applicant that all adults residing in the home have criminal record/TB clearances. The facility will operate Monday-Saturday 7am-10pm and with a license capacity of 14 children. LPA went over the childcare ratios for a large family child care home with applicant and provided applicant a copy. Physical Plant: This is a single story home that consists of 2 bedrooms, 2 bathrooms, living room, kitchen, laundry room, front yard, and backyard fenced. The home was toured; the following areas are used for daycare: living room, bedroom #2 which is utilized as a nap room, bathroom, and back yard. Off limit areas include: front yard, kitchen bedroom #1 and bathroom located inside bathroom #1. The licensee tested the dual smoke and carbon monoxide alarm located on the living room ceiling. LPA heard the alarm and it was functioning. LPA Garcia observed the required 2A10BC fire extinguisher located in the kitchen; arrow was in the green indicating it is fully charged. LPA reminded licensee that fire extinguisher must be replaced or serviced annually, taping the receipt of purchased to the fire extinguisher. LPA Garcia also observed the pull-down fire alarm station located near the entrance of the home. The home has electrical outlet covers throughout and maintains a First Aid Kit in the kitchen shelf above the kitchen.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 6

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: AZIZYAN FAMILY CHILD CARE	FACILITY NUMBER: 197700701
	VISIT DATE: 07/24/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

There are adequate age-appropriate toys, books, games, and napping cots located in the napping room. Per licensee, she will move some children to nap in the living room if the bedroom becomes crowded. There are no firearms present in the home and there is no smoking on the premises as stated by Licensee.
The facility sketch is complete and current, there is working telephone (cell). Fire/Disaster Drills document are maintained current and last conducted on 6/3/24.

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 accessible to children.

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 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.

Kitchen: The kitchen is off limits and licensee installed child safety gates to prevent access in the kitchen. The home has a clean and fully stocked clean refrigerator/freezer. Cleaning supplies were observed to be kept under the kitchen sink cabinet and secured with safety lock. LPA observed the stove to have child safety knobs installed. Breakfast, lunch, dinner and snacks are provided, and licensee participates in a food program. Licensee is advised food brought from the children’s home shall be properly stored, labeled, and dated.

Outdoor: Children play in the back yard. The outdoor play area is surrounded by 3 property walls (2 concrete brick, 1 vinyl fence). On the left side of the back yard, there is a small vinyl fence that prevents children from accessing this portion of the yard that is off limits. There is a pergola and sun sail shades that provide adequate shading for the children.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024

LIC809 (FAS) - (06/04)

Page: 2 of 6

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: AZIZYAN FAMILY CHILD CARE	FACILITY NUMBER: 197700701
	VISIT DATE: 07/24/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Back yard is free of hazards and has sufficient toys. The play area is clear and clean of debris, play area is fenced and gated all around, play yard has artificial grass and cement brick for play time. LPA observed a metal shed in the backyard on the right side of the back yard. LPA observed the outdoor air conditioner in the backyard accessible and is located within the area that is off limits and inaccessible to the children. LPA observed age-appropriate toys and equipment for children.

Advisory/Other: First Aid kit was observed with supplies (thermometer) readily available. Licensee has a valid Pediatric CPR/First Aid certification dated 4/28/24, and Mandated Reporter is current and dated 2/9/23. 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 and Small Child Care Ratio Packet. Licensee stated currently does not have childcare insurance.

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 was also discussed with the licensee:
1. 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.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024

LIC809 (FAS) - (06/04)

Page: 3 of 6

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: AZIZYAN FAMILY CHILD CARE	FACILITY NUMBER: 197700701
	VISIT DATE: 07/24/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

2. 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.

4. 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.

5. 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.

6. 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.

7. 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.

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

9. Smoking is prohibited in the family childcare home.

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

11. 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.

12. 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.

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

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024

LIC809 (FAS) - (06/04)

Page: 4 of 6

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: AZIZYAN FAMILY CHILD CARE	FACILITY NUMBER: 197700701
	VISIT DATE: 07/24/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

14. 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).

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

13. Dog(s) and/or pets are recommended to be isolated from children in care.

14. 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.

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.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024

LIC809 (FAS) - (06/04)

Page: 5 of 6

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: AZIZYAN FAMILY CHILD CARE	FACILITY NUMBER: 197700701
	VISIT DATE: 07/24/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

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/.

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.

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.

During the exit interview, the LICENSEE Nelli Azizyan, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

There are no corrections needed and facility is ready for Large Family Child Care License.

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

interview conducted and report was reviewed with the licensee, Nelli Azizyan.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024

LIC809 (FAS) - (06/04)

Page: 6 of 6