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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020342
Report Date: 06/20/2023
Date Signed: 06/20/2023 02:32:26 PM

Document Has Been Signed on 06/20/2023 02:32 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:DAVOIAN FAMILY CHILD CAREFACILITY NUMBER:
198020342
ADMINISTRATOR:ASTKHIK DAVOIANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 223-7516
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 13DATE:
06/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Astkhik Davoian, LicenseeTIME COMPLETED:
03:00 PM
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REQUIRED- 1 YEAR INSPECTION CONDUCTED IN ARMENIAN
Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced required 1- year inspection to the above facility on 06/20/23. LPA arrived at the facility at 11:20 AM and met with Astkhik Davoian, 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 Zarui Davoyan and Hripsime Galstyan, Licensee’s Assistants. Per licensee, facility hours are Monday to Friday from 7:30 a.m. to 6:30 p.m. LPA provided a copy of Entrance Checklist—Family Child Care Home (LIC126) to licensee.

This is a one story home located on the first level. The home consists of 3 bedrooms, 1 bathroom, kitchen, living room (FIREPLACE: inaccessible), front yard, and backyard (fenced). Per licensee, parents enter the home through the main entrance which leads to the living room.

There is a detached ADU in the backyard with separated address, 1304 E. Harvard Street Unit A, Glendale, CA 91205.
The children use the living room, 1 bathroom in the hallway, two bedrooms, kitchen, and backyard (fenced). Per licensee, areas off limits to children and parents include: 1 bedroom, and front yard. LPA did not observe stairs in the home during this inspection. 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 11:50 a.m., Licensee took this LPA on a tour of the home. LPA was toured through the interior starting with the living room where observed a screen was installed to the fireplace to prevent access. LPA observed 11 children were playing in the living room with licensee and her two
REPORT CONTINUES ON NEXT PAGE 1 of 5
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: DAVOIAN FAMILY CHILD CARE
FACILITY NUMBER: 198020342
VISIT DATE: 06/20/2023
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assistants. LPA observed children toys in the living room. A safety gate was installed to the kitchen entrance to prevent access. Next LPA toured the first daycare bedroom adjacent to the living room and observed children chairs and a table in the bedroom and it was set up as a classroom. Next LPA toured the second daycare bedroom adjacent to the kitchen and observed two infants were napping in the pack n play. LPA observed two pack n' plays and four beds in the bedroom. Next LPA toured the one bathroom in the hallway and observed child proof safety latches on the cabinet under the sink. The restroom that children use was observed to be safe and sanitary. Next LPA toured the kitchen and observed a children table and chairs, two high chairs, one adult table and four chairs in the kitchen. Per licensee, children either eat outside or in the kitchen. LPA observed child proof safety latches on the cabinets where licensee stores sharp items and cleaning compounds. There are first aid supplies available on the premises in the kitchen. LPA observed the required 2A 10BC fire extinguishers were anchored to the wall by the entrance door and in the kitchen. There were serviced on 09/05/22 as read by LPA from the service tag. Licensee tested the carbon monoxide and smoke detectors 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 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 (fenced) for outdoor play time. 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. LPA observed the off-limit back of backyard and off-limit detached ADU in he backyard is separated by a gate to make it inaccessible to the children.

Per Licensee, 12:20 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 not to be operating within the licensed capacity and is exceeding the required limitations during this inspection. During this inspection total of 13 children were present in the home, four being infants and one being school age. Licensee was operating out of ratio with one infant. All adults present have obtained a criminal record clearance on Licensing Information System (LIS). Per licensee, currently she has two assistants.
REPORT CONTINUES ON NEXT PAGE 2 of 5
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
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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: DAVOIAN FAMILY CHILD CARE
FACILITY NUMBER: 198020342
VISIT DATE: 06/20/2023
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The licensee has completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 12/24. Licensee, completed required mandated reporter training on 06/26/22. LPA advised licensee that if a child shows signs of illness he/she/they shall be separated from other children.

At 12:30 p.m., facility roster was reviewed and was not updated. Per licensee currently there are 14 children enrolled. LPA reviewed 5 children's records, including emergency information from 14 enrolled children, and all 5 reviewed files were completed. The licensee and her two 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 06/19/23. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted at the wall by the entrance in the living room.

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 and stays at the facility during operation hours. Per licensee she carries liability insurance in accordance with standard established by Family Child Care statue.

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 5
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
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: DAVOIAN FAMILY CHILD CARE
FACILITY NUMBER: 198020342
VISIT DATE: 06/20/2023
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INFANT CARE: Licensee states that she is providing care to infants and currently has four infants enrolled in her daycare. Licensee states that infants sleep in the one daycare bedroom and living room where they are constantly supervised. Appropriate sleeping arrangements and cribs were observed. (one crib 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.

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 and quarterly updates online at: www.ccld.ca.gov.
REPORT CONTINUES ON NEXT PAGE 4 of 5
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
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: DAVOIAN FAMILY CHILD CARE
FACILITY NUMBER: 198020342
VISIT DATE: 06/20/2023
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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.

LPA Eivazian informed licensee, Astkhik Davoian that this report dated 06/20/23 documents 1 Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Eivazian informed the licensee, Astkhik Davoian to provide a copy of this licensing report dated 06/20/23 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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, Astkhik Davoian at 3:00 p.m..



REPORT END 5 of 5
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/20/2023 02:32 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 06/20/2023 at 01:11 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: DAVOIAN FAMILY CHILD CARE
FACILITY NUMBER: 198020342

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/20/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(d)(1)
Staffing Ratio and Capacity
(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: (1) Twelve children, no more than four of whom may be infants; or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA 's observation, the licensee did not comply with the section cited above, during this inspection total of 13 children were present in the home, four being infants and one school age which poses an immediate health, safety or personal rights risk to persons in care.
Licensee was observed to operate out of required license limitation with one infant.
POC Due Date: 06/21/2023
Plan of Correction
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Per licensee, she will drop one or two children in order to meet required staffing ratio and capacity. An updated facility roster and a written declaration will be submitted to LPA Eivazian by 06/21/23.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: 06/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2023


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Document Has Been Signed on 06/20/2023 02:32 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 06/20/2023 at 01:11 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: DAVOIAN FAMILY CHILD CARE
FACILITY NUMBER: 198020342

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/20/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on facility roster review, the licensee did not comply with the section cited above and did not have current facility roster which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/30/2023
Plan of Correction
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Per licensee, she will update her facility roster and a copy will be to LPA Eivazian by 06/30/23 via email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: 06/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2023


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