198006764-12-20-2024-33-CC-POCA-DC5VNF-20241220153503

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198006764
Report Date: 12/20/2024
Date Signed: 12/20/2024 03:35:12 PM

Document Has Been Signed on 12/20/2024 03:35 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	KHODAGULYAN FAMILY CHILD CARE		FACILITY NUMBER:	198006764
ADMINISTRATOR/ DIRECTOR:	KHODAGULYAN, ALIS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 957-0042
CITY:	LA CRESCENTA	STATE: CA	ZIP CODE:	91214
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 8	CENSUS: 6	DATE:	12/20/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:35 PM
MET WITH:	Licensee, Alis Khodagulyan		TIME VISIT/ INSPECTION COMPLETED:	03:50 PM

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On December 20, 2024, at 1:35 pm Licensing Program Analysts (LPA) Priscilla Ochoa conducted an unannounced annual inspection at the above facility. LPA was greeted by licensee, Alis Khodagulyan who guided LPA on a tour of the facility. Licensee’s spouse and assistant were also present during the inspection. All adults present during the inspection have criminal record clearance. Per licensee there are 8 children enrolled and LPA observed 6 children in care. Hours of operation are Monday through Sunday form 7:30 am to 5:30 pm. LPA provided a copy of Entrance Checklist—Family Childcare Home (LIC126) to licensee.

Family members residing in the home are 3 adults who have criminal record clearance. This is a one-story home which consists of 3 bedrooms, 2 bathrooms, attic, living room, dining room, kitchen, detached garage, front yard, and backyard which is fenced.

Off limit areas include one bed room, attic, kitchen, living room, dining room, detached garage, and front yard.

Areas accessible to children are bedroom 1 (daycare room) which is located in the hallway next to the dining room, bedroom two which is next the daycae room, bathroom in hallway and backyard which is fenced.

At 1:40 pm, licensee guided LPA on a tour of the areas that are accessible to the children in care. Parents enter through the side of the home through a gate. This gate lead parents to the backyard and then have access to the daycare room. LPA observed children napping in care. Napping equipment was observed in the form of mats.

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Ana Chico	TELEPHONE: (323) 981-3379
Priscilla Ochoa	TELEPHONE: 323-981-3350
	DATE: 12/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024

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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KHODAGULYAN FAMILY CHILD CARE	FACILITY NUMBER: 198006764
	VISIT DATE: 12/20/2024

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Napping equipment was observed to be clean and orderly. Per licensee, parents take home bedding every Friday to be washed. In the daycare room, LPA observed several age-appropriate toys for children in care. Bedroom 2 was inspected and LPA observed a bed and children's crib. The mattress on the crib did have an appropriate size mattress with fitted sheets. The crib was observed to be free of loose items. Children in care use the restroom that is located in the hallway next to the dinning room. The restroom was inspected and was clean. LPA did not observe any materials that can pose a danger to children. LPA then inspected the backyard which is fenced and observed more age-appropriate toys for children in care. LPA observed fireplace in the living room that is screened making it inaccessible to children. All areas were observed to be clean, orderly, comfortable, and well ventilated. Licensee is current caring for 2 infants. LPA observed a sleep log (LIC 9227) for each infant.

There are first aid supplies available. Per licensee, the facility provides all meals and snacks to daycare children.

Licensee's poisons, detergent, cleaning compounds, medications and other items which could pose a danger to child are stored where they are inaccessible to children.

LPA observed a Smoke/Carbon Monoxide Detector in the hallway next to the restroom area. LPA did not test Smoke/Carbon Monoxide Detector as children were napping. A 2A-10BC fully charged fire extinguisher was observed and served on 07/04/2024. There is a working telephone on site.

Per the licensee, there are no firearms or pets on the premises. Licensee obtained current Pediatric First Aid and CPR certification expires on 04/27/2025.

LPA conducted a children file review and deemed complete. LPA conducted staff file review and deemed complete.

Licensee completed Mandated Reporter training and expires on 5/01/2026. All childcare employees must complete mandated reporter training within 30 days of hire and renew training every two years at www.mandatedreporterca.com

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SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3379
LICENSING EVALUATOR NAME: Priscilla Ochoa	TELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024

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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KHODAGULYAN FAMILY CHILD CARE	FACILITY NUMBER: 198006764
	VISIT DATE: 12/20/2024

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Per the licensee, fire and disaster drills are conducted every 6 months; last drill documented and conducted on 9/11/2024.

Licensee has the required documents posted in the FCCH; Facility License (LIC 203), Notification of Parents' Rights Poster (PUB 394), Emergency Disaster Plan (LIC610a), Earthquake Preparedness (LIC 9148) on licensing board in the daycare room.

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

Licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B. The on Duty Worker is available for questions Monday through Friday at (323) 981-3350 from 8:00 AM - 5:00 PM.

The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000. Also call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).

The licensee was informed that the presence of adults in the home without Criminal Record Clearance or Exemption will be cited and civil penalty assessed for $100 per day. The licensee may find additional information and forms on the DSS website at www.ccld.ca.gov including information on the Live Scan application (LIC 9163). Appointments can be made for Live Scan at 1-800-315-4507

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SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3379
LICENSING EVALUATOR NAME: Priscilla Ochoa	TELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024

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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KHODAGULYAN FAMILY CHILD CARE	FACILITY NUMBER: 198006764
	VISIT DATE: 12/20/2024

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The following was discussed with the licensee:
Capacity requirements, Roster requirements, Posting requirements, Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children’s files and provider’s files, and Safe Sleep Awareness. The role and responsibilities of being a mandated reporter were reviewed. Licensee was reminded that supervision is always required to children in care.

Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility’s phone number; if the phone number is changed, licensing must be notified.

Regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.

--Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.

-- Our Quarterly updates come out every 3 months they are also now in Spanish please log in to the CCLD website or you can email our advocates to have the quarterly updates send directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov

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 [or facility representative] 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.

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SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3379
LICENSING EVALUATOR NAME: Priscilla Ochoa	TELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024

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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KHODAGULYAN FAMILY CHILD CARE	FACILITY NUMBER: 198006764
	VISIT DATE: 12/20/2024

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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

The licensee, Alis Khodagulyan confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

LPA provided consultation during inspection.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no deficiencies being issued today, December 20, 2024.

A notice of site visit was given and must remain posted for 30 days during facility’s hours of operation. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and a copy of the report was provided to licensee, Alis Khodagulyan.

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SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3379
LICENSING EVALUATOR NAME: Priscilla Ochoa	TELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024

LIC809 (FAS) - (06/04)

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