197700728-11-3-2023-12-CC-AVIA-CX8SDY-20231103134755

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700728
Report Date: 11/03/2023
Date Signed: 11/03/2023 01:48:48 PM

Document Has Been Signed on 11/03/2023 01:48 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:	GRIGORYAN FAMILY CHILD CARE		FACILITY NUMBER:	197700728
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	11/03/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Narine Grigoryan, Applicant		TIME COMPLETED:	02:30 PM

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On November 3, 2023, Licensing Program Analysts (LPA) Annelise Villa conducted a pre-licensing inspection with Applicant Narine Grigoryan, who guided LPAs on a tour of the facility. This is a one-story house with 3 bedrooms, and 2 bathrooms, living room, dining room, and kitchen. The adults residing in the home are applicant. The children will use the living room for napping and playing. LPAs observed cots that the children will use for napping.

The facility will operate Monday through Friday from 6:00 am to 6:00 pm, 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.

Main care will be provided in bedrooms #1 and #2. Children will eat at tables set up in the bedroom #1. The day care children will utilize the bathroom accessible through bedroom #1. Off limit areas will be bedrooms #3, bathroom #2 located in the hallway, kitchen, living room, dining room, and front yard.

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 3A40BC fire extinguisher during the inspection located in bedroom #2. First aid kit is located in a cabinet in the hallway. Per applicant, medications are stored in the kitchen, in an upper cabinet. The off-limit bedrooms have safety latches out of reach of the children, making it inaccessible. Cleaning items are inaccessible to children stored underneath the kitchen sink and in the hallway closet which has a safety latch which was observed to be operable by LPA.

Continued on LIC 809-C

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

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: GRIGORYAN FAMILY CHILD CARE	FACILITY NUMBER: 197700728
	VISIT DATE: 11/03/2023

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Kitchen: The kitchen will be off limits to children in care. The kitchen was observed to be clean and orderly. The following are inaccessible: Sharp items are stored in a kitchen drawer with safety latches. LPA observed the refrigerator and freezer to be clean and fully stocked. 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 will not be participating in a food program.

Outdoor: Children will use a portion of the back yard for outdoor play. The accessible portion of the yard is separated from the off limits section by baby gates and fenced all around. The front yard is off limits to children in care. LPA observed the back yard to be free of garden tools, poisonous plants, thorn trees cactus, or lawn mower inaccessible to children, when ready. There are 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: 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

Continued LIC 809-C

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

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: GRIGORYAN FAMILY CHILD CARE	FACILITY NUMBER: 197700728
	VISIT DATE: 11/03/2023

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Advisory/Other: 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 family room. 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.

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 November 3, 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: 11/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

LIC809 (FAS) - (06/04)

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