198020824-7-30-2021-33-CC-AEIN-C5EPDM-20210730111346

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020824
Report Date: 07/30/2021
Date Signed: 07/30/2021 11:13:56 AM

Document Has Been Signed on 07/30/2021 11:13 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:	MUSHEGHYAN FAMILY CHILD CARE		FACILITY NUMBER:	198020824
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	07/30/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Artyom Musheghyan, Applicant		TIME COMPLETED:	11:30 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	PRELICENSING INSPECTION CONDUCTED IN ARMENIAN Licensing Program Analyst (LPA) Anomeh Eivazian conducted an announced pre-licensing inspection to the above facility on 07/30/2021. LPA arrived at the facility at 8:30 AM and met with Artyom Musheghyan, Applicant who guided analyst on a tour of the facility. During this inspection individuals who reside in the home were discussed and notes on Confidential Name List (LIC811) and attached to this report. Per applicant operation hours will be Monday to Friday, 7:00 a.m. to 6:00 p.m.. Applicant states she will care for children 0-12 years old. All areas identified on the facility sketch were inspected. This is a one story duplex home located on the first level. The home consists of 1 bedroom, 1 restroom, living room, kitchen, front yard and backyard (fenced). There is a pending application for 363 W. Acacia , Glendale, CA 91204 with facility number 198020837, which is located next door and backyard is shared between 361 and 363 W. Acacia , Glendale CA 91204 applicants. Areas that are accessible to children are as follows: Entire home which consists of living room, kitchen, one bedroom, one bathroom and front part of back yard (fenced) . Areas off limits based on facility sketch submitted to children and parents include: Back of backyard and front yard. Rooms that are off-limits need to be made inaccessible during operating hours Per applicant children will use the front part of backyard (fenced) for outdoor activity. Per applicant he will share the front part of backyard with applicant located next door at 363 W. Acacia , Glendale CA 91204. A written declaration indicating staggered use of backyard (fenced) for outdoor activity will be submitted. The applicant does understand that licensing staff may have access to off-limit areas during inspection visit if necessary. REPORT CONTINUES ON NEXT PAGE 1 of 5

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021

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: MUSHEGHYAN FAMILY CHILD CARE	FACILITY NUMBER: 198020824
	VISIT DATE: 07/30/2021

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At 8:45 a.m., the applicant began touring LPA’s through the home starting with the entry way which lead directly to the living room, The living room was inspected and electrical outlets were observed to be covered. LPA did not observe any objects in the living room. Next LPA toured the kitchen and observed child proof safety latches on the cabinets where applicant stores sharp items and cleaning compounds. Next LPA toured the bathroom and one bedroom and did not observe any hazards. During this inspection LPA did not observe applicant's personal belongings in the home and the home was empty. (Pictures were taken). Per applicant he has not move to this address completely. LPA observed the required 2A 10BC fire extinguisher was anchored to the wall in the kitchen. It was serviced on 07/02/21 as read by LPA from the service tag.
applicant tested the carbon monoxide and smoke detectors in the living room. It sounded off the alarms and heard by LPA to be functional. During this inspection Emergency Supplies were not available in the premies.

The applicant states that they will provide food for children in care. Applicant was advised that if food is brought from the children’s homes, all containers must be labeled with child’s name and properly stored or refrigerated. Per applicant, at 9:45 a.m., there are no pets, weapons, firearms or bodies of water on the premises. During this inspection LPA did not observe toys in the home. There is not telephone service available in the home. LPA advised applicant that if a child shows signs of illness he/she/they shall be separated from other children.

Applicant has proof of CPR and First Aid training as indicated on the certificate. The applicant does have proof of Health and Safety training (completion date: 06/05/2021), Pediatric First Aid and CPR (ex. 06/2023).

The following was discussed with the applicant:
Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
-In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.
REPORT CONTINUES ON NEXT PAGE 2 of 5

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021

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: MUSHEGHYAN FAMILY CHILD CARE	FACILITY NUMBER: 198020824
	VISIT DATE: 07/30/2021

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-A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
-Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License shall be terminated.
-The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should check and batteries replaced as needed.
-Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
-Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report)
-Fire and safety drills must be performed every six months and documented for review by the Department.
-Smoking is prohibited in a family child care home.
-Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
-Dog(s) and or pets are recommended to be isolated from children in care.
- No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.
-All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
- Applicant shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.
- Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.

SAFE SLEEP: LPA discussed the safe sleep regulations with applicant, Artyom Musheghyan 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.

REPORT CONTINUES ON NEXT PAGE 3 of 5

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021

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: MUSHEGHYAN FAMILY CHILD CARE	FACILITY NUMBER: 198020824
	VISIT DATE: 07/30/2021

NARRATIVE

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INFANT CARE: Applicant states that he care for infants. Applicant states that infants will sleep in the living room and bedroom where they are constantly be supervised. Appropriate sleeping arrangements and cribs will be available once an infant being enrolled. LPA informed one crib for each infant in care will be needed. 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 informed Applicant infants can not be swaddled while in care. LPA advised the Applicant 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 Applicant. LPA provided the Applicant 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 .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

During this inspection LPA discussed PIN 20-06 CCP, Social And Physical Distancing Guidance And Healthy Practices For Child Care Facilities In Response To The Global Coronavirus (COVID-19) Pandemic Written In Collaboration With The California Department Of Education and reviewed Child Care Covid-19 Self Assessment.

Per applicant, there are no dual licenses at this address. Applicant’s email address was obtained during this inspection. The applicant was advised that email may be public information.

REPORT CONTINUES ON NEXT PAGE 4 of 5

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021

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: MUSHEGHYAN FAMILY CHILD CARE	FACILITY NUMBER: 198020824
	VISIT DATE: 07/30/2021

NARRATIVE

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Per applicant, she does not carry liability insurance or a bond in accordance with standard established by Family Child Care statue. Signed statements (LIC282) will be on children’s files. The law requires Family Child Care provider to carry liability insurance or bond in the amount of $300,000 annually or to maintain the signed statement in the facility file.
The applicant has proof of immunization against influenza, pertussis, and measles.
Applicant completed required mandated reporter training on 07/14/2021. Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com
LPA advised the applicant how to access forms, regulations and quarterly updates, and Provider Information Notices (PIN) on the Child Care Licensing website at: www.ccld.ca.gov. LPA reviewed and issued the Forms/Records to Keep in Your Family Child Care Home (LIC 311D) and provided the following forms:CHILDREN FORMS/RECORDS , FACILITY FORMS/RECORDS , INFORMATION TO BE POSTED IN YOUR FAMILY CHILD CARE HOME . The following corrections need to be corrected prior to obtaining a small family child care license. Corrections are due by 08/31/2021

1. Applicant will fully move to this address and bring his personal belongings in the home and set up the home as a daycare.

2. Applicant will submitted a written plan to share the backyard (fenced) on staggered scheduled with Anahit Beglaryng, applicant next door with facility number 198020837.
3. Applicant will add railing to the stairs which leads to the backyard.
4. Applicant will have toys available in the home.
5. Applicant will have emergency supplies available in the home.
6. Applicant will submit an updated facility sketch to include 363 W. Acacia home in the sketch.
7. Applicant will have working phone available in the home.
LPA inquired into the applicant's practices related to COVID-19. Applicant stated that he practice hygiene such as hand washing with the children. Applicant has hand sanitizer available in the drop off area and inside his home. Applicant states they practice social distancing with children, staff and parents will wear masks all the times indoors and will teach children about wearing proper face covering. LPA reviewed Child Care Program Covid-19 Self Assessment with applicant during this inspection.
A small family child care license will be granted upon receipt of proof of corrections for the above. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license.
The applicant’s signature on this report acknowledges that they have signed the Application for a Family Child Care Home License (LIC 279) under the penalty of perjury that the statements on the application and any attachments are correct.
Exit interview conducted and report was reviewed with the Applicant, Artyom Musheghyan at 11:30 a.m..
REPORT END 4 of 4

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021

LIC809 (FAS) - (06/04)

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