198020430-10-5-2021-33-CC-AEIN-C7HPKP-20211005112329

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020430
Report Date: 10/05/2021
Date Signed: 10/05/2021 11:23:41 AM

Document Has Been Signed on 10/05/2021 11:23 AM - 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:	SARGSYAN FAMILY CHILD CARE		FACILITY NUMBER:	198020430
ADMINISTRATOR:	ANNA SARGSYAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(424) 224-1698
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91202
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 5	DATE:	10/05/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Anna Sargsyan, Licensee		TIME COMPLETED:	11:40 AM

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 10/05/2021. LPA arrived at the facility at 8:20 AM and met with Anna Sargsyan, Licensee who guided analyst on a tour of the facility. Also present during this inspection, was Askhen Gasparyan, Licensee’s mother/ assistant. Per licensee, Anna Sargsyan facility hours are Monday to Friday from 8:00 a.m. to 8:00 p.m. This is a two story home which consists of 2 bedrooms, 1 restroom, dining room, living room, kitchen, patio, laundry room, garage and front yard in the first floor and second floor consists of 3 bedrooms, 2 bathrooms, and balcony. Satires which leads to the second floor has been barricaded properly to prevent access to second floor. Per licensee the children use the bathroom in the hallway in the first floor, living room, dining room, two bedrooms in the first floor, kitchen and patio. Per licensee areas off limits to children and parents include: Laundry room, garage, and entire second floor which consists of 3 bedrooms, 2 bathrooms and balcony. 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 8:45 a.m., Licensee took this LPA on a tour of the home. LPA was toured through the interior starting with the living room where LPA observed sofas, coffee table and TV. There is a fireplace in the living room which has been blocked off to prevent access to children. Licensee also tested the carbon monoxide and smoke detector in the living room. It sounded off the alarms and heard by LPA to be functional. Next LPA toured the kitchen were all cleaning compounds and sharp times were inaccessible to the children. LPA observed the required 2A 10BC Fire Extinguisher was anchored to the wall. It was serviced on 09/01/2021 as read by LPA from service tag. REPORT CONTINUES ON NEXT PAGE 1 of 4

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021

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 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: SARGSYAN FAMILY CHILD CARE	FACILITY NUMBER: 198020430
	VISIT DATE: 10/05/2021

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
26
27
28
29
30
31
32

Next LPA toured the off-limit laundry room and garage and did not observe any hazards. LPA observed the door in the kitchen which leads to the laundry room was closed. LPA observed a safety gate was installed to the stairs which leads to off-limit second floor. Next LPA toured the second floor off-limit three bedrooms, two bathrooms and a balcony and did not observe any hazards. Next LPA toured the two daycare rooms in the first floor and observed all electrical outlets were covered. LPA observed children table, chairs, toys and a TV in daycare rooms. Next LPA toured the half bathroom and did not observe any hazards. LPA observed a safety gate was installed to the daycare room. 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 patio fenced (day care outdoor activity area) and did not observe any hazards. LPA observed the patio ground was covered with turf. LPA observed that the outdoor yard has toys, a swing 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 10:00 a.m., there are no pets or bodies of water on the premises. Per licensee there is a fire arm in the facility that is stored in off-limit area. Per licensee currently there is not ammunition in the home. LPA observed the fire arm was stored in off-limit bathroom and trigger was locked and firing pin was removed.

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 5 children present in the facility. All adults present have obtained a criminal record clearance on Licensing Information System (LIS). Per licensee, Anna Sargsyan at 10:05 a.m. currently she has one assistant. 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.

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 09/2023. Licensee, Anna Sargsyan completed required mandated reporter training on 10/01/2021. There are first aid supplies available on the premises in the daycare area. LPA advised licensee 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: 10/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021

LIC809 (FAS) - (06/04)

Page: 2 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: SARGSYAN FAMILY CHILD CARE	FACILITY NUMBER: 198020430
	VISIT DATE: 10/05/2021

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
26
27
28
29
30
31
32

At 10:15 a.m., facility roster was reviewed and completed. Per licensee currently there are 7 children enrolled. LPA reviewed 7 children's records, including emergency information from 7 enrolled children, and all 7 reviewed files were completed. The licensee and her assistant 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 09/15/2021 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, her husband and father smoke in the home but in the street and off-limit areas. 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 7 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: 10/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021

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: SARGSYAN FAMILY CHILD CARE	FACILITY NUMBER: 198020430
	VISIT DATE: 10/05/2021

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
26
27
28
29
30
31
32

INFANT CARE: Licensee states that currently she has one 23 months old child enrolled in her daycare. Licensee states that infants sleep in the daycare area where they are constantly supervised. Appropriate sleeping arrangements and cribs were observed. (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 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, take children temperature daily, licensee and staff wear masks all the times indoor and teaching children about wearing proper face covering.
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. 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. Exit interview conducted and report was reviewed with the Licensee, Anna Sargsyan at 11:40 .m..

REPORT END 4 of 4

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021

LIC809 (FAS) - (06/04)

Page: 4 of 4