198020549-10-20-2021-33-CC-SROZ-C7XVAN-20211019161614

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020549
Report Date: 10/19/2021
Date Signed: 10/20/2021 09:11:29 AM

Document Has Been Signed on 10/20/2021 09:11 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:	GYUMUSHYAN FAMILY CHILD CARE		FACILITY NUMBER:	198020549
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS:	DATE:	10/19/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:05 PM
MET WITH:	Mariam Gyumushyan		TIME COMPLETED:	04:45 PM

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	Licensing Program Analysts (LPA) Steven Rodriguez conducted an unannounced annual required inspection at the above facility on 10/19/21 at 2:00 PM. LPA met with Mariam Gyumushyan, Licensee who guided analysts on a tour of the facility at 2:10 pm. LPA observed no children to be in care at the time of the visit. Licensee states she has not had children in care since September but is looking to add kids soon. This is a one-story home which consists of four bedrooms, two bathroom, kitchen, living room. Areas accessible to children were inspected as follows: Living room, dedicated learning room directly accessible after entering the front door entrance, 1 bedroom and 1 bathroom, front yard. Main care is provided in the playroom which is also the living room and can be accessed from the main entrance. The children use the bathroom that is down the hall from the living room on the left side. LPA observed there is no wall heater or fireplace. The house contains central air. Per Licensee, the off-limit area is the master bedroom, bedroom number three (brother's room), kitchen, and the back rooms. Children do not play in the back yard. Only areas used are play area, restroom. Bedroom #1 for sleeping, bedroom number two (licensees room for sleeping) Hours of operation is Monday-Friday 8 am - 5:30 pm. Individuals residing in the home have been discussed and noted. There are three adults total living in the home. All have clearance and have been associated. Licensee states that there are no firearms or weapons stored in the home. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is operable telephone service at the facility via cell phones and land line.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Steven Rodriguez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2021

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: GYUMUSHYAN FAMILY CHILD CARE	FACILITY NUMBER: 198020549
	VISIT DATE: 10/19/2021

NARRATIVE

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The following was observed and reviewed during this inspection:
LPA's observed that cleaning products are stored on a high shelf with a child lock, inaccessible to children. The licensee states that there are no poisons stored in the home. Isolation area for sick children waiting to be picked up is located in either the learning room or bedroom #1 that is not occupied away from other children.

The valve on the required 2A 10BC fire extinguisher indicates fully charged and has a service date of 07/12/2021. Smoke and carbon monoxide detectors were tested and are operable (dual).

The home is observed to be clean and orderly. There are toys and other age appropriate material available for children. Children nap on cots in bedroom #1. The bathroom that children use was observed to be clean and free of hazards.

Infant Care: Currently the licensee has no infants in care. LPA informed licensee of the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15 minute check documentation for infants 0-24 months, and provided PIN 20-24-CCP.

Children use the front yard for outdoor play. LPA did not observe any objects that could be hazardous to children in care. There are no pools or spas, or other bodies of water.

The licensee does have proof of Pediatric CPR and first aid. Expiration date is 10/01/2023. Licensee does have proof of immunization against pertussis, and measles. Declination of flu vaccine from the licensee on file. Mandated Reporter AB 1207 compliant Child Care Training Certificate on file. Exp 08/09/2022.

Incidental Medical Services (IMS):
The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. Incidental Medical Services (IMS) policy was discussed. 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 ------Page 2

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Steven Rodriguez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: GYUMUSHYAN FAMILY CHILD CARE	FACILITY NUMBER: 198020549
	VISIT DATE: 10/19/2021

NARRATIVE

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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.

Health and Safety Code 1596.7996 Effective January 1, 2019, Child Care Centers and Family Child Care Homes are required to provide parents and guardians of children enrolled, enrolling or reenrolling in care with written information on the risks and effects of lead exposure, blood lead testing requirements and recommendations and options for locations of affordable blood lead tests. 2019 Lead flyer Provided.

Based on the LPA's observations and records review no deficiencies will be cited today 10/19/21.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with licensee Mariam Gyumushyan but not limited to Appeal Procedures and Appeal Rights.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Steven Rodriguez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2021

LIC809 (FAS) - (06/04)

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