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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020430
Report Date: 10/08/2025
Date Signed: 10/08/2025 02:55:23 PM

Document Has Been Signed on 10/08/2025 02:55 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:SARGSYAN FAMILY CHILD CAREFACILITY NUMBER:
198020430
ADMINISTRATOR/
DIRECTOR:		ANNA SARGSYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(424) 224-1698
CITY:GLENDALESTATE: CAZIP CODE:
91202
CAPACITY: 14TOTAL ENROLLED CHILDREN: 19CENSUS: 9DATE:
10/08/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:40 AM
MET WITH:Anna Sargsyan, LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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ANNUAL INSPECTION CONDUCTED IN ARMENIAN

Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced annual/random inspection to the above facility on 10/08/25. LPA arrived at the facility at 11:40 AM and met with Anna Sargsyan, Licensee who guided analyst on a tour of the facility. Also present during this inspection were Greta Evoyan and Narine Tadevosyan, Licensee’s assistants. LPA provided a copy of Entrance Checklist—Family Child Care Home (LIC126) to licensee. Per licensee, Anna Sargsyan facility hours are Monday to Friday from 8:00 a.m. to 8:00 p.m.. Per licensee, she provides care to children 0-14 years old.

This is a two-story home located on the first floor. The home consists of 5 bedrooms, 2 & ½ restrooms, dining room, living room, kitchen, patio, laundry room, garage, second floor balcony, and front yard. Per licensee, parents enter the facility through the main entrance which leads to the living room and side gate which leads to the patio.

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. Per licensee, children only walk through the living room and dining room to go to the patio. 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 11:45 AM a.m., Licensee took this LPA on a tour of the home. LPA was toured through the interior starting with the living room and dining room where LPA observed sofas, a coffee table


REPORT CONTINUES ON NEXT PAGE 1 of 4
NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/08/2025
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
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: SARGSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020430
VISIT DATE: 10/08/2025
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and a TV. There is a fireplace in the living room which has been blocked off to prevent access to children. LPA observed a child safety gate was installed to the stairs in the living room which leads to the second floor to make the second floor inaccessible to the 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 in the kitchen. It was serviced on 07/01/25 as read by LPA from service tag. 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 being closed. Next LPA toured the day care room and observed 9 children were present in the facility, in the daycare room playing with licensee and her two assistants. LPA observed children toys, tables, a TV and chairs in the daycare room. LPA observed a child safety gate was installed in the daycare room to make the rest of the home inaccessible to the children. Next LPA toured the daycare second room and observed children napping cots and toys in the bedroom. Next LPA toured the half bathroom in the first floor and did not observe any hazards. LPA observed all electrical outlets were covered in the daycare area. 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 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 12:20 p.m., there are no pets, fire arms and 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 9 children were present in the home, one being 16 months old infant, with licensee and her two assistants. All adults presents have obtained a criminal record clearance on Licensing Information System (LIS). Per licensee, Anna Sargsyan at 12:50 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 4
NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025
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: SARGSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020430
VISIT DATE: 10/08/2025
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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 09/2026. Licensee, Anna Sargsyan completed required mandated reporter training on 09/17/24. 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.

At 12:55 p.m., facility roster was reviewed and completed. Per licensee currently there are 19 children enrolled. LPA reviewed 6 children's records, including emergency information from 19 enrolled children, and all 6 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 09/12/25 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 in the daycare 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, her husband smokes 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 carries liability insurance in accordance with standard established by Family Child Care statue. Per licensee, she provides transportation.

SAFE SLEEP LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/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 https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.


REPORT CONTINUES ON NEXT PAGE 3 of 4
NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025
LIC809 (FAS) - (06/04)
Page: 4 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: SARGSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020430
VISIT DATE: 10/08/2025
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INFANT CARE: Licensee states that currently she has one 16 months old infant enrolled in her daycare. Licensee states that infants sleep in the daycare area where they are constantly supervised. 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. Nap cart was completed for one enrolled infant.

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.

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.


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

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee, Anna Sargsyan, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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.

Exit interview conducted and report was reviewed with the Licensee, Anna Sargsyan.

REPORT END 4 of 4
NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025
LIC809 (FAS) - (06/04)
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