198020048-10-12-2021-33-CC-AEIN-C7QSB7-20211012134328

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020048
Report Date: 10/12/2021
Date Signed: 10/12/2021 01:43:40 PM

Document Has Been Signed on 10/12/2021 01:43 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	PETROSYAN FAMILY CHILD CARE		FACILITY NUMBER:	198020048
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 3	CENSUS: 3	DATE:	10/12/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Marine Petrosyan, Licensee		TIME COMPLETED:	02:00 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	ANNUAL INSPECTION CONDUCTED IN ARMENIAN Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced annual inspection to the above facility on 10/12/2021. LPA arrived at the facility at 8:20 AM and met with Marine Petrosyan, Licensee who guided analyst on a tour of the facility. Per licensee, Marine Petrosyan facility hours are Monday to Saturday, 7am to 12am. This is a two story home on a property with two additional, detached units in the rear with separated address, unit A and B. The units in the rear are rented out and tenants have fingerprint clearances on file. This home consists of 2 bedrooms, 2 full restrooms, living room (FIREPLACE: inaccessible), and kitchen on the ground floor, the second floor has a storage room and family room (licensee's bedroom), front yard, backyard (fenced), and the basement located outside (locked). Per licensee, parents enter the facility through the main entrance door. Per licensee the children use the living room, one bedroom, one bathroom in the hallway of bedrooms, kitchen and backyard (fenced). Per licensee, children only walk through the kitchen to go to the backyard. Per licensee areas off limits to children and parents include: Second floor which consists of storage room and family room, front yard, and basement. LPA observed stairs which leads to the second floor was inaccessible by a door for children under the age of 5. During this inspection individuals who reside in the home were discussed and notes on Confidential Name List (LIC811) and attached to this report. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. At 9:00 a.m., Licensee took this LPA on a tour of the home. LPA was toured through the interior starting with the living room (daycare classrooms), LPA observed sofas, a TV, two high chairs, children tables and chairs in the living room. LPA observed all electrical outlets were covered in living room. Next LPA toured the one bedroom and observed children napping cots in the bedroom. REPORT CONTINUES ON NEXT PAGE 1 of 4

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

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 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PETROSYAN FAMILY CHILD CARE	FACILITY NUMBER: 198020048
	VISIT DATE: 10/12/2021

NARRATIVE

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Next LPA toured the one bathroom in the hallway and observed child proof safety latches on the cabinet under the sink, storage above the sink and shower doors. Next LPA toured the one off-limit bedroom and one off-limit bathroom in the ground floor and did not observe any hazards. LPA observed plastic door knobs on the off-limit door knobs. Next LPA opened the door and toured the off-limit second floor which consists of a storage room and family room. LPA observed licensee's bedroom and personal belongings in the second floor. LPA observed the door which leads to the second floor was closed and a safety latch was placed on the door knob. Next LPA toured the kitchen in the first floor and observed child proof safety latches on the cabinets where licensee stores sharp items and cleaning compounds. Per licensee, children only walk through the kitchen to go to the backyard. LPA observed a safety gate was installed to the kitchen to make it inaccessible to the children. LPA observed licensee's family members personal belongings in the home. LPA observed two required 2A 10BC fire extinguisher were anchored to the wall by the main entrance and in the kitchen. Both were serviced on 10/01/21 as read by LPA from the service tag. Licensee tested the carbon monoxide detector in the living room and smoke detector the hallway of bedrooms. Both sounded off the alarms and heard by LPA to be functional. Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. 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. There are emergency supplies available in the home in the kitchen.

Next LPA toured the backyard fenced. Currently, children are using the back yard for outdoor play time. The outdoor play area was observed to be fenced. Per licensee, children use the gated turf area for outdoor activity and use the cement area for bike. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that can pose a danger to children on the outdoor yard. The licensee states that supervision is always provided.

Per Licensee, at 10:40 a.m. there are no pets, weapons, firearms, pools, spas, hot tubs, fish ponds, or similar bodies of water on the premises.

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 10/2023. Licensee, Marine Petrosyan completed required mandated reporter training on 10/01/2021. LPA advised licensee at xxx that if a child shows signs of illness he/she/they shall be separated from other children.

REPORT CONTINUES ON NEXT PAGE 2 of 4

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

LIC809 (FAS) - (06/04)

Page: 2 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PETROSYAN FAMILY CHILD CARE	FACILITY NUMBER: 198020048
	VISIT DATE: 10/12/2021

NARRATIVE

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The licensee was observed to be operating within the licensed capacity and is not exceeding the required limitations during this inspection. During this inspection there were three children present in the home with licensee in the living room. All adults present have obtained a criminal record clearance on Licensing Information System (LIS). Per licensee, currently she does not any assistants. Licensee 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.

At 11:00 a.m., facility roster was reviewed and completed. Per licensee currently there are 3 children enrolled. LPA reviewed 3 children's records, including emergency information from 3 enrolled children, and all 3 reviewed files were completed. The licensee does not have proof of immunization against influenza, pertussis, and measles.

All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Last drill documented was conducted on 09/08/2021 as read by LPA from the disaster drill log. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted at the wall by the entrance. LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home. There is telephone service via a cellphone that is used and the cellphone stays at the facility during operation hours. Per licensee she does not carry liability insurance or a bond in accordance with standard established by Family Child Care statue. Signed statements (LIC282) on 3 reviewed files.

SAFE SLEEP: LPA discussed the safe sleep regulations with licensee, and discussed the Child Care Licensing Safe Sleep webpage at http://www.cdss.ca.gov/inforescources/child-care-licensing/public-information-and-resoucrces/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 http://www/cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. Boppy recall: https://www.cpsc.gov/Recalls/2021/The-Boppy-Company-Recalls-Over-3-Million-Original-Newborn-Loungers-Boppy-Preferred-Newborn-Loungers-and-Pottery-Barn-Kids-Boppy-Newborn-Loungers-After-8-Infant-Deaths-Suffocation-Risk

REPORT CONTINUES ON NEXT PAGE 3 of 4

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

LIC809 (FAS) - (06/04)

Page: 3 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PETROSYAN FAMILY CHILD CARE	FACILITY NUMBER: 198020048
	VISIT DATE: 10/12/2021

NARRATIVE

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INFANT CARE: Licensee states that currently she does not have any infants enrolled in her daycare. Licensee states that if an infant is enrolled, the infant will sleep in the daycare bedroom and living room where they are constantly supervised. Appropriate sleeping arrangements and cribs will be available. (one crib for each infant in care is required). Cribs or play yard shall not hinder the entrance or exit from the sleeping space, mattresses shall be firm and covered with a fitted sheet that overlaps the underside so it cannot be dislodged. Cribs and play yards shall be free of loose articles and objects. No objects shall be hanging above or attached to the side of the crib. LPA did not observe any infants swaddled while in care. LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. A copy of the LIC 9227 was provided to Licensee. LPA provided the licensee with a copy of A Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. LPA also consulted and explained Child Abuse Reporting, Never Shake a Baby, and Safe Sleeping practices.
Medication: Incidental Medical Services (IMS) policy was discussed. The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. 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.
LPA advised the licensee to access forms, regulations, providers information notiees (PINS), and quarterly updates online at: www.ccld.ca.gov.
LPA inquired into the licensee’s practices related to COVID-19. Licensee stated that they practice hygiene such as hand washing with the children. Licensee has hand sanitizer available in the drop off area and inside her home. Licensee states they practice social distancing with children, licensee wear masks all the times indoor. During this inspection LPA observed 3 present children were not wearing masks and LPA issued a Technical Assistant to licensee to enforce face covering indoors effective immediately.
At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today from the areas that were inspected today. The Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.
To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experienced. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding inspection tools and methods, please visit the Program website at www.cdss.gov/inforesouces/community-care-liceinsing/inspection-process . Exit interview conducted and report was reviewed with the Licensee, Marine Petrosyan at 2:00 p.m..

REPORT END 4 of 4

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

LIC809 (FAS) - (06/04)

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