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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020048
Report Date: 09/12/2024
Date Signed: 09/12/2024 03:18:52 PM

Document Has Been Signed on 09/12/2024 03:18 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 CAREFACILITY NUMBER:
198020048
ADMINISTRATOR/
DIRECTOR:		MARINE PETROSYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 404-4197
CITY:GLENDALESTATE: CAZIP CODE:
91203
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 12DATE:
09/12/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Marine Petrosyan, LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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ANNUAL INSPECTION CONDUCTED IN ARMENIAN
Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced required 1- year inspection to the above facility on 09/12/24. LPA arrived at the facility at 12:00 PM and met with Marine Petrosyan Licensee who guided analyst on a tour of the facility. A COVID 19 risk assessment was conducted prior to entering the facility. Also present during this inspection, were Inesa Galstyan, Licensee’s Daughter, Rita Keshishyan and Satenik Yeritsyan, licensee's assistants. Per licensee, Marine Petrosyan facility hours are Monday to Saturday from 8:00 a.m. to 5:30 p.m. LPA provided a copy of Entrance Checklist—Family Child Care Home (LIC126) to licensee. Upon LPA's arrival 12 children, two being infants were present in the home.

This is a two story home located on the first floor. There are two additional, detached units in the rear with separated addresses, unit A and B.

Licensee's daughter, Inessa Galstyan applied for Family Child Care Home license at 355 Salem A, Glendale, CA 91203 with facility number, 198021510.

This home consists of 2 bedrooms, 2 full restrooms, living room (FIREPLACE: inaccessible), and kitchen on the first 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: One bedroom in the first floor, 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. During this inspection individuals who reside in the home were discussed and notes on Confidential Name List (LIC811) and attached to this report.
REPORT CONTINUES ON NEXT PAGE 1 of 7
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2024
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PETROSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020048
VISIT DATE: 09/12/2024
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All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. At 12:15 p.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 a sofa, a TV, five high chairs, children tables and chairs in the living room. LPA observed all electrical outlets were covered in living room. There is a fireplace in the living room which has been blocked off to prevent access. LPA observed 12 children, two being infants were playing in the living room. Next LPA toured the one bedroom adjacent to the living room and observed children napping cots and two pack n'play in the bedroom. Next LPA toured the kitchen and observed child proof safety latches on the cabinets where licensee stores sharp items and cleaning compounds. LPA observed a safety gate was installed to the kitchen. Next LPA toured the bathroom in the hallway and did not observe any hazards. LPA observed off-limit bedrooms door and door which leads to the second floor were closed during this inspection and had child proof safety latches on it.
LPA observed the required 2A 10BC fire extinguisher was anchored to the wall in the kitchen. It was serviced on 10/03/23 as read by LPA from the service tag. Licensee tested the carbon monoxide detector in the living room and smoke detector in 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 there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock.

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. 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. LPA observed off-limit areas in the backyard are fenced and inaccessible to the children. The licensee states that supervision is always provided.

Per Licensee, Marine Petrosyan at 1:30 p.m there are no pets, weapons, firearms, pools, spas, hot tubs, fish ponds, or similar bodies of water on the premises.
The licensee was observed to be operating within the licensed capacity and is not exceeding the required limitations during this inspection. During this inspection 12 children were present in the facility with licensee and her two assistants. All adults present have obtained a criminal record clearance on Licensing Information System (LIS). Per licensee, Marine Petrosyan at 1:40 p.m. currently she has two 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.
REPORT CONTINUES ON NEXT PAGE 2 of 7
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PETROSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020048
VISIT DATE: 09/12/2024
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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 11/2025. Licensee, Marine Petrosyan completed required mandated reporter training on 10/01/2021. Licensee did not have current mandated reporter certificate during this inspection. There are first aid supplies available on the premises in the kitchen. LPA advised licensee that if a child shows signs of illness he/she/they shall be separated from other children. Per licensee she provides transportation.

At 1:30 p.m., facility roster was reviewed and completed. Per licensee currently there are 12 children enrolled. LPA reviewed 5 children's records, including emergency information from 12 enrolled children, and completed. The licensee has proof of immunization against influenza, pertussis, and measles. Licensee's assistant have proof of immunization against measles but did not have proof of immunization against pertussis and influenza on file. 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 08/15/24.

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 landline that is used at the facility during operation hours.
Per licensee she carries liability insurance in accordance with standard established by Family Child Care statue. Signed statements (LIC282) on 5 reviewed files.

INFANT CARE: Licensee states that she is providing care for infants. Per licensee, currently she has two infants enrolled in her day care, over one year old. Licensee states that infants sleep in the living room and daycare bedroom where they are constantly supervised. Appropriate sleeping arrangements and cribs were observed. 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 was not completed for two infants who were under 12 months of age. A copy of the LIC 9227 was provided to Licensee.
REPORT CONTINUES ON NEXT PAGE 3 of 7
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024
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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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PETROSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020048
VISIT DATE: 09/12/2024
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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

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.

During this inspection LPA Eivazian reviewed and discussed with the licensee the following Title 22 Regulations to ensure licensee will maintain compliance and always meet the Title 22 regulations.

Provider must reside in the home where care is being provided:
Definitions--102352(f)(1) -- "Family Day Care" or "Family Child Care" means regularly provided care, protection, and supervision of children, in the care giver's own home, for periods of less than 24 hours per day, while the parents or authorized representatives are away. The term "Family Child Care" supersedes the term "Family Day Care" as used in previous regulations and "Home" means the licensee's residence as defined by Government Code Section 244.
Provider must be present 80% of the time providing care as stated in the following regulation:

REPORT CONTINUES ON NEXT PAGE 5 of 7
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PETROSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020048
VISIT DATE: 09/12/2024
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Operation of a Family Child Care Home--102417 (a)-- The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

Reporting Requirements--102416.2 (a) (2) --Any change in household composition including adults moving in or out of the home and anyone living in the home who reaches his or her 18th birthday.

Inspection Authority of the Department—102391 (a)--Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation of, the regulations adopted by the Department governing family child care homes, and in accordance with Section 102396.

LPA Eivazian explained to the licensee that Licensee is required to operate separately from other providers regardless of family relationships. Licensee’s daughter, Inessa Galstyan applied for a family childcare home license with facility number 198021510 located at 355 Salem A, Glendale, CA 91203 as backhouse of the licensee's home.

The Department addressed the licensee requirement for enrolled children to be at this facility all the time during daycare hours. Enrolled children’s parents are required to be fully aware and clear on who is the licensee and caregiver to the children in care. Co-mingling of children between the two separate licenses is a violation of Title 22 regulations.

Per licensee, Marine Petrosyan facility Rosters and children's files for enrollment will be updated.
- Licensee will always interact with Department staff professionally and respectfully.
- Licensee understands that inspections are conducted in person, unannounced, and Department staff will be granted access to the facility as part of the inspection process.
- Licensee will be forthright with the department at all the times to ensure the health and safety of children in care.
- Licensee will be the main person to provide care to the children and interact with families.
REPORT CONTINUES ON NEXT PAGE 6 of 7
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PETROSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020048
VISIT DATE: 09/12/2024
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Per licensee, Marine Petrosyan she is planning to use the outdoor playground as staggered scheduled with Galstyan FCC, 198021510. Per licensee, she is planning to use the backyard for outdoor playtime from 9:30 AM to 10:15AM and 4:30 PM to 5:00PM, and Galstyan FCC, 198021510 from 10:15 AM to 11:00AM and 4:00PM to 4:30 PM.

Licensee submitted a written declaration signed and dated 08/26/24 that she resides at this address, she will never combine her daycare children with Galstyan FCC, 198021510 children.

LPA advised the licensee to access forms, regulations and quarterly updates online at: www.ccld.ca.gov.



The following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

The Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

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 .
REPORT END 7 of 7
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024
LIC809 (FAS) - (06/04)
Page: 6 of 7
Document Has Been Signed on 09/12/2024 03:18 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 09/12/2024 at 12:43 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PETROSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020048

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on licensee's file review, the licensee did not comply with the section cited above and licensee did not have current mandated reporter training certificate on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/27/2024
Plan of Correction
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Per licensee, she will have her mandated reporter training certificate by plan of correction due date.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) 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. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on staff file review, the licensee did not comply with the section cited above and licensee's assistants, Rita Keshishyan and Satenik Yeritsyan did not have proof of immunization against Pertussis and Influenza on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/27/2024
Plan of Correction
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Per licensee, her two assistants will have proof of immunization against pertussis and influenza by plan of correction due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Christina Gabelman
LICENSING EVALUATOR NAME:Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2024


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