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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020964
Report Date: 01/18/2022
Date Signed: 01/18/2022 11:16:18 AM

Document Has Been Signed on 01/18/2022 11:16 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:SARKISYAN FAMILY CHILD CAREFACILITY NUMBER:
198020964
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
01/18/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Nelli Sarkisyan, ApplicantTIME COMPLETED:
11:30 AM
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PRELICENSING INSPECTION CONDUCTED IN ARMENIAN
Licensing Program Analysts (LPA) Anomeh Eivazian and David Kurdoglyan conducted an announced pre-licensing inspection to the above facility on 01/18/2022. LPAs arrived at the facility at 8:40 AM and met with Nelli Sarkisyan, 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, 8:00 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 home located on the first level. The home consists of 2 bedrooms, 1 restroom, living room, dining room, kitchen, front yard, two detached storages in the backyard, detached garage, and backyard. There is a fireplace in the living room which has been blocked off to prevent access to children. Per applicant parents will enter the home through the main entrance which leads to the living room.
Areas that are accessible to children are as follows: Bathroom in the hallway, living room, dining room, kitchen, and front part of backyard.

Areas off limits based on facility sketch submitted to children and parents include: Two bedrooms, front yard, two detached storages in the backyard, detached garage, and back of backyard. There is a gate at the end of the backyard which leads to an alley towards the Geneva Street.
**Rooms that are off-limits need to be made inaccessible during operating hours**
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 6
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2022
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: SARKISYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020964
VISIT DATE: 01/18/2022
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At 9:00 am, 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. LPAs observed a dining table, chairs, a children table and chairs in the living room. There is a fireplace in the living room which has been blocked off to prevent access. Next LPAs toured the dining room and observed sofas and a coffee table in the dining room. Next LPAs toured the two off-limit bedrooms and did not observe any hazards. LPAs observed applicant's family members personal belongings in the home. Next LPAs toured the bathroom in the hallway and observed child proof safety latches on the cabinets where applicant stores cleaning compounds. LPAs observed shampoos and conditioners were stored in high level storage in the shower out of reach of children. Next LPAs toured the kitchen and observed child proof safety latches on the cabinets where applicant stores sharp items and cleaning compounds. Per applicant there is no poison in the home. LPAs observed the required 2A 10BC fire extinguisher was anchored to the wall by the entrance door in the living room. It was purchases on 01/04/2022 as read by LPA from the receipt. Applicant tested the carbon monoxide detector in the hallway of bedrooms and smoke detectors in the living room. 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.

Next LPAs toured the backyard. Per applicant children only will use the front part of the backyard for outdoor activity. Back of backyard which is off-limit areas has been separated by 6 feet high vinyl gates. Per applicant children will walk through the kitchen to go to the backyard. Per applicant she will add a gate to the backyard outdoor area to be safe for children. The applicant states that supervision is always provided. Next LPAs toured the two detached storages and detached garage and did not observe any hazards. Per applicant she will keep the off-limit storages and garage doors locked all the times during daycare hours.

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 10:00 am, there are no weapons, firearms or bodies of water on the premises. Per applicant there is a dog on the premises which will be inaccessible to the children. There are toys available for children. There is telephone service via a cellphone that is used and the cellphone stays at the facility during operation hours. LPA advised applicant that if a child shows signs of illness he/she/they shall be separated from other children.
REPORT CONTINUES ON NEXT PAGE 2 of 6
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2022
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: SARKISYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020964
VISIT DATE: 01/18/2022
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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: 11/18/2021), Pediatric First Aid and CPR (ex. 09/2023). The applicant and her daughter have proof of immunization against influenza, pertussis, and measles. Applicant completed required mandated reporter training on 10/28/2021. Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com

The following was discussed with the applicant:
Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.
-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.
-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.
REPORT CONTINUES ON NEXT PAGE 3 of 6
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2022
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: SARKISYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020964
VISIT DATE: 01/18/2022
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 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.

INFANT CARE: Applicant states that she care for infants. Applicant states that infants will sleep in the living room where they are constantly be supervised. Appropriate sleeping arrangements and cribs will be available once an infant being enrolled. LPAs informed one crib for each infant in care will be needed. 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 shall be free of loose articles and objects. No objects shall be hanging above or attached to the side of the crib. LPAs informed Applicant infants can not be swaddled while in care. LPAs 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. LPAs provided the Applicant with a copy of A Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. LPAs also consulted and explained Child Abuse Reporting, Never Shake a Baby, and Safe Sleeping practices.

SAFE SLEEP: LPAs discussed the safe sleep regulations with applicant 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 applicant 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 4 of 6
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: SARKISYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020964
VISIT DATE: 01/18/2022
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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.



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.

LPA consulted and explained Child Abuse Reporting, Effects of Lead Exposure Flyer, Updated Patent’s Rights Poster with Complaint Hotline information, Capacity Handout (Small & Large) was provided during this inspection.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

REPORT CONTINUES ON NEXT PAGE 5 of 6
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2022
LIC809 (FAS) - (06/04)
Page: 6 of 6
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: SARKISYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020964
VISIT DATE: 01/18/2022
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To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.


The following corrections need to be corrected prior to obtaining a small family child care license. Corrections are due by 02/18/2022.

1. Applicant will add plastic door knobs on main entrance door and two off-limit bedrooms door knobs.
2. Applicant will cover outside stairs gate opening which leads to the backyard to make it safe for the children.
3. Applicant will add a fence to the backyard outdoor playarea to make it safe for the children.
4. Applicant will submit an updated Yard facility sketch to include off-limit areas in the backyard.

LPAs inquired into the applicant's practices related to COVID-19. Applicant stated that she practice hygiene such as hand washing with the children. Applicant has hand sanitizer available in the drop off area and inside her home. Applicant states they practice social distancing with children, take children temperature daily, applicant, staff, children above two years old and parents will wear masks all the times indoors and will teach children about wearing proper face covering. LPAs 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, Nelli Sarkisyan at 11:30 a.m..

REPORT END 6 of 6

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

DATE: 01/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2022
LIC809 (FAS) - (06/04)
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