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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015912
Report Date: 07/28/2023
Date Signed: 07/28/2023 02:57:29 PM

Document Has Been Signed on 07/28/2023 02:57 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:BOULGHOURJIAN FAMILY CHILD CAREFACILITY NUMBER:
198015912
ADMINISTRATOR:BOULGHOURJIAN, EMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 636-4684
CITY:PASADENASTATE: CAZIP CODE:
91104
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
07/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Ema Boulghourjian - LicenseeTIME COMPLETED:
03:25 PM
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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced annual random inspection to the above facility. At 1:25pm, LPA met with licensee, Ema Boulghourijan. Also present during this inspection, is Licensee’s husband. The licensee states that she currently has 4 children enrolled. A current children’s roster is available and is current. Licensee’s hours of operation are 7:30am-4pm, Monday-Friday.

This is a one-story home which consists of 4 bedrooms, 2 bathrooms, kitchen, dining area, living room, front den, back den (daycare room) detached garage, front yard and backyard (fenced). The children use 3 Bedrooms for nap, back den (daycare room), bathroom, and backyard. Per licensee, areas off limits to children and parents include: front den, living room, dining room, kitchen, Master bedroom, detached garage, and front yard. All areas identified on the facility sketch were inspected. The licensee provides food for children in care.

The licensee states that 2 adults and 0 children currently live in the home. Persons living in the home are identified on the attached LIC811. Licensee states that she has three assistant. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. Per licensee, there are no weapons, firearms or bodies of water on the premises.

PHYSICAL PLANT


At 1:35pm, LPA was lead on a tour of the facility by the licensee. Children in care are dropped off through the backdoor of the home. The backdoor leads directly into the daycare room. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are observed to be posted. There are age appropriate toys and equipment present for children. There are high chairs and a play yard. Per licensee, high chairs are only used during feeding time. Directly outside the daycare room to the left is the bathroom for children in care. Detergents, cleaning compounds, medications, and other items which could pose a danger are inaccessible to children. The tour continued to the first room next to the bathroom. There are three cribs available for children in care to use for nap. There is also a chair available for licensee to sit and supervise.
REPORT CONTINUES PAGE 1 of 3
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2023
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: BOULGHOURJIAN FAMILY CHILD CARE
FACILITY NUMBER: 198015912
VISIT DATE: 07/28/2023
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Smoke and carbon monoxide detectors were tested and are operable. Tour continued down the hall to the "middle" room which also has a crib available in it for a child in care. Per licensee, the middle room will be used as an area for an ill child until an authorized representative comes to pick up child. LPA reviewed the kitchen next. Per licensee, sharp knives are kept inaccessible to children in care and were observed to be out of reach. At 1:45pm, a fire extinguisher was observed. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 04/13/2023, as indicated on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. There are first aid supplies available. The licensee states that a cell phone is used and stays at the facility during operating hours. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock.

At 1:50pm, LPA observed the back yard area. The outdoor play area was observed to be fenced. At this time, children are using the back yard for outdoor play time. There was plenty of open space for children in care to run and play. LPA observed playhouses, small slides, carts, bikes, and additional equipment for children in care to play. The licensee is observed to be operating within the license capacity limitations.

FACILITY RECORDS:


The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 04/2025. Licensee and other personnel have completed mandated reporter training that expires 07/27/2024. The licensee does have proof of immunization against influenza, tuberculosis, pertussis, and measles. Children’s records were reviewed, including but not limited to, a copy of the emergency information card that contains all the information specified by regulation.

The following was discussed:


-There are no pets on the premises
-Infant Walkers, Johnny Jumpers, Saucer Chairs, and/or any other item that falls into these categories are not permitted in a family child care facility.
-Smoking is prohibited in a license family child care home.

LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov. AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/

REPORT CONTINUES PAGE 2 of 3

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: BOULGHOURJIAN FAMILY CHILD CARE
FACILITY NUMBER: 198015912
VISIT DATE: 07/28/2023
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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 22-02- CCP. 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.

During the exit interview, the Licensee, 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.

Exit interview conducted and report was reviewed with the licensee Ema Boulghourjian, at 3:05pm,



END OF REPORT PAGE 3 of 3
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3