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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020225
Report Date: 06/09/2022
Date Signed: 06/09/2022 03:17:59 PM

Document Has Been Signed on 06/09/2022 03:17 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:GRIGORYAN FAMILY CHILD CAREFACILITY NUMBER:
198020225
ADMINISTRATOR:GAYANE GRIGORYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 653-9295
CITY:GLENDALESTATE: CAZIP CODE:
91201
CAPACITY: 14TOTAL ENROLLED CHILDREN: 13CENSUS: 12DATE:
06/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Gayane Grigoryan, LicenseeTIME COMPLETED:
03:30 PM
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ANNUAL INSPECTION CONDUCTED IN ARMENIAN
Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced annual required and case- management inspection to the above facility on 06/09/2022. Licensee submitted an updated facility sketch to LPA on 06/07/2022 and requested to inspect newly added two daycare rooms in order to use for daycare. LPA arrived at the facility at 12:30 PM and met with Gayane Grigoryan, Licensee who guided analyst on a tour of the facility. Also present during this inspection, were Araksyan Gasparyan, licensee's assistant and Vahe Grigoryan, licensee's son. At 1:45 p.m. licensee's assistant, Ani Stepanyan arrived to the facility. Per licensee, Gayane Grigoryan facility hours are Monday to Friday from 7:00 a.m. to 11:00 p.m. LPA provided a copy of Entrance Checklist—Family Child Care Home (LIC126) to licensee at 11 am.

This is a one story home which consists of 2 bedrooms, 2 and 1/2 bathrooms, Kids play room, Kids bedroom, kitchen, dining room, living room (FIREPLACE: inaccessible), front yard, backyard (fenced), detached storage in the backyard. Per licensee at 1:00 p.m. the children use the Kids playroom, kids bedroom, half bathroom in Kids playroom, and daycare outdoor activity area in the backyard. Per licensee, parents enter the facility through the side gate which leads to the backyard and daycare rooms. Per licensee areas off limits to children and parents include: 2 bedrooms, living room, dining room, kitchen, two bathroom, front yard, off-limit area in the backyard and detached storage in the backyard. 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 1:00 p.m., Licensee took this LPA on a tour of the home. LPA was toured through the interior starting with Kids playroom..Upon LPA's arrival LPA observed 12 children with licensee and her assistant in Kids Playroom finishing lunch and getting ready for nap. LPA observed children tables, chairs, 5 high chairs, two pack n' plays and toys in the Kids Play room.
REPORT CONTINUES ON NEXT PAGE 1 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/09/2022
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 4
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: GRIGORYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020225
VISIT DATE: 06/09/2022
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 Next LPA toured the Kids Bedroom and observed 4 pack n'play and napping cots in the Kids Bedroom. Next LPA toured the half daycare bathroom in Kids Playroom and did not observe any hazards. LPA observed all electrical outlets were covered in daycare area. Next LPA toured the off-limit living room, dining room, kitchen, two bathroom, two bedrooms and did not observe any hazards. LPA observed the required 2A 10BC fire extinguisher was placed in the daycare half bathroom. It was serviced on 06/08/2022 as read by LPA from the service tag. Licensee tested the carbon monoxide and smoke detectors in the Kids Playroom. It 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.

Next LPA toured the backyard fenced. Currently, children are using the back yard for outdoor play time. Licensee, children walk through the Kids Playroom to the backyard and go to the designated daycare outdoor activity area which is separated by 6 feet vinyl walls. The outdoor play area was observed to be fenced. The outdoor activity space is covered by artificial grass. 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 1:25 p.m. there is a one dog on the premises which is kept in the backyard and inaccessible to the children. Per licensee, there are no 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 exceeding the required limitations during this inspection. LPA's arrival at 12:30 p.m. there were total of 12 children present in the facility three being infants and 9 being preschoolers with licensee, and her assistant. All adults present have obtained a criminal record clearance on Licensing Information System (LIS). Per licensee, Gayane Grigorayn 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 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022
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: GRIGORYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020225
VISIT DATE: 06/09/2022
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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 10/2022. Licensee, completed required mandated reporter training on 06/13/2021. There are first aid supplies available on the premises in the kids bedroom. LPA advised licensee that if a child shows signs of illness he/she/they shall be separated from other children. At 1:45 p.m., facility roster was reviewed and completed. Per licensee currently there are 13 children enrolled. LPA reviewed 10 children's records, including emergency information from 13 enrolled children, and all 10 reviewed files were completed.
The licensee and her assistants 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 04/13/2022. 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 10 reviewed files.
INFANT CARE: Licensee states that she is caring for infants. Licensee states that infants sleep in the Kids playroom and bedroom where they are constantly supervised. Appropriate sleeping arrangements and cribs were observed. (one pack n'play for each infant in care was observed). Cribs or play yard did 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 were observed to be free of loose articles and objects. No objects were observed to be hanging above or attached to the side of the crib. LPA did/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.
REPORT CONTINUES ON NEXT PAGE 3 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: GRIGORYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020225
VISIT DATE: 06/09/2022
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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.

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. 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, Gayane Grigoryan at 3:30 p.m..
REPORT END 4 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4