197700753-2-16-2024-12-CC-EGAA-D2HPA7-20240216100815

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700753
Report Date: 01/05/2024
Date Signed: 02/16/2024 10:08:27 AM

Document Has Been Signed on 02/16/2024 10:08 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:	MKHITARYAN/ASILBEKYAN FAMILY CHILD CARE		FACILITY NUMBER:	197700753
ADMINISTRATOR:	NUNE MKHITARYAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 482-3632
CITY:	SUN VALLEY	STATE: CA	ZIP CODE:	91352
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	01/05/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Edwad Asilbekyan, Nune Mkhitaryan		TIME COMPLETED:	01:15 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	Licensing Program Analyst (LPA) Evelyn Garcia conducted a Capacity Increase inspection and change of location inspection. Upon arrival, LPA met with licensee Edward Asilbekyan. 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, 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. Upon arrival, LPA observed 0 children in care. Other residents of the home include co-licensee, Nune Mkhitaryan. Applicant presented evidence of property control. Their minor daughter lives in the front home with her grandmother Vardush Mkhitaryan who has been fingerprinted and cleared. LPA confirmed with applicant that all adults residing in the home have criminal record/TB clearances. The facility will operate Monday through Saturday 7:30am-10:30pm and with a license capacity of 14 children. LPA went over the childcare ratios for a small family home with applicant and provided applicant a copy. Physical Plant: This is a ADU located on the back property that consists of 1 bedroom (nap room), 1 bathroom, living space, kitchen, dining area, side yard, and backyard fenced. The home was toured; the following areas are used for daycare: living room, kitchen, bedroom, bathroom and back yard. Off limit areas include: front yard, garage and front property. Drawers and lower cabinets in kitchen/bathroom are either latched and do not contain any hazardous items. Per licensee, he stated that all cleaning supplies are kept in the shed or garage which is off limits. There is an operational smoke alarm and fire extinguisher maintained in the home along with the pull down fire alarm station. The home has electrical outlet covers throughout and maintains a First Aid Kit in the kitchen top cabinet. There are adequate age appropriate toys, books, games, and napping cots located in the napping room. The outdoor play area is fenced with brick and metal gate. Back yard is free of hazards and has sufficient toys. There are no firearms present in the home and there is no smoking on the premises as stated by Licensee.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024

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: MKHITARYAN/ASILBEKYAN FAMILY CHILD CARE	FACILITY NUMBER: 197700753
	VISIT DATE: 01/05/2024

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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). Fire/Disaster Drills were not available during visit.

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.

Bathroom: Bathtub and shower are free of hazards. Licensee stated cleaning supplies are kept in garage or shed and cabinet only contained personal hygiene items and had safety latch to make inaccessible to children.

Kitchen: The home has a clean and fully stocked clean refrigerator/freezer. Breakfast, lunch, snacks will be provided and parents will have the option to bring their own food from home. 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 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 to be gated by a self latch gate. LPA also observed a wooden shed in the backyard that is locked and inaccessible. LPA observed the outdoor air conditioner in the backyard accessible. LPA advised that a barricade is installed to prevent children’s access to the blades and cautioned licensee about rose bushes in brick planters along the wall near the pergola, increased supervision or mesh fence to prevent brushing against the thorns. LPA observed age-appropriate toys for children.

Advisory/Other: First Aid kit was observed with supplies (thermometer) readily available. Licensee has a valid CPR/First Aid certification dated 6/21/22, and Mandated Reporter is current and dated 6/26/23 and 7/4/23. 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.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024

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: MKHITARYAN/ASILBEKYAN FAMILY CHILD CARE	FACILITY NUMBER: 197700753
	VISIT DATE: 01/05/2024

NARRATIVE

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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, and Lead Poisoning flyer's. 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.

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.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024

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: MKHITARYAN/ASILBEKYAN FAMILY CHILD CARE	FACILITY NUMBER: 197700753
	VISIT DATE: 01/05/2024

NARRATIVE

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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.

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.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024

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: MKHITARYAN/ASILBEKYAN FAMILY CHILD CARE	FACILITY NUMBER: 197700753
	VISIT DATE: 01/05/2024

NARRATIVE

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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.

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.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024

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: MKHITARYAN/ASILBEKYAN FAMILY CHILD CARE	FACILITY NUMBER: 197700753
	VISIT DATE: 01/05/2024

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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 Edward Asilbekyan, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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

interview conducted and report was reviewed with the licensee Edward Asilbekyan

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024

LIC809 (FAS) - (06/04)

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