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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020964
Report Date: 12/01/2023
Date Signed: 12/01/2023 03:56:47 PM

Document Has Been Signed on 12/01/2023 03:56 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:SARKISYAN FAMILY CHILD CAREFACILITY NUMBER:
198020964
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
12/01/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Nelli Sarkisyan, LicenseeTIME COMPLETED:
03:50 PM
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CASE MANAGEMENT INSPECTION CONDUCTED IN ARMENIAN
Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced case- management inspection to the above facility on 12/01/23 due to licensee is requesting capacity increase. LPA arrived at the facility at 12:20 PM and met with Nelli Sarkisyan, Licensee who guided analyst on a tour of the facility. A COVID 19 risk assessment was conducted prior to entering the facility. Also present during this inspection, was Shushanik Baghdasaryan, Licensee’s Assistant. Per licensee, Nelli Sarkisyan facility hours are Monday to Friday from 8:00 a.m. to 6:00 p.m. Fire Clearance was granted on 11/03/23.

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, one detached storage in the backyard. Per licensee parents enter the home through the main entrance which leads to the living room or side gate which leads to the back yard.
There is newly built ADU in the back on the home with separated address. Per licensee, unit A tenants have their own entrance from the back of the property.

Per licensee the children use the bathroom in the hallway, living room, dining room, kitchen, one bedroom adjacent to the kitchen and backyard (fenced). Per licensee areas off limits to children and parents include: One bedroom, front yard, one detached storage in the backyard. There is a gate in the backyard which leads to ADU in the back of the home. Per licensee, she keeps the backyard gate closed all the time and it is not used by backhouse tenants. LPA did not observe stairs in the home. 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 12:30 pm, the licensee 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
REPORT CONTINUES ON NEXT PAGE 1 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: 12/01/2023
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observed to be covered. LPA observed children tables and chairs in the living room. LPA observed two children were playing in the living room with licensee. During this inspection four children were dropped off and total of 6 children were present in the home. There is a fireplace in the living room which has been blocked off to prevent access. Next LPA toured the dining room and observed sofas and a coffee table in the dining room. LPA observed a fish tank out of reach of children in the dining room. Next LPA toured the one daycare bedroom and observed napping cots and children toys in the bedroom. Next LPA toured the one off-limit bedroom and did not observe any hazards. LPA observed licensee's family members personal belongings in the home. Next LPA toured the bathroom in the hallway and observed child proof safety latches on the cabinets where licensee stores cleaning compounds. LPA observed shampoos and conditioners were stored in high level storage in the shower out of reach of children. Next LPA toured the kitchen and observed child proof safety latches on the cabinets where licensee stores sharp items and cleaning compounds. Also LPA observed two child safety gates were installed to kitchen two entrances. Per licensee there is no poison in the home. LPA observed the required 2A 10BC fire extinguisher was anchored to the in the living room. It was purchases on 01/04/2022 as read by LPA from the receipt and was not serviced annually as it is required. Licensee 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 LPA toured the backyard (fenced). Per licensee, children use the backyard for outdoor activity. Per licensee, children walk through the kitchen to go to the backyard. LPA observed backyard is gated and separated from back unit by 6 feet high vinyl gates. The licensee states that supervision is always provided. Next LPAs toured the two detached storages and detached garage and did not observe any hazards. Per licensee, she keeps the off-limit storage locked all the times during daycare hours.

Per licensee, she provides food for children in care. Licensee 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 Licensee, Nelli Sarkisyan at 1:40 p.m there are no weapons, firearms, pools, spas, hot tubs, or similar bodies of water on the premises. Per licensee, there is a small dog on the premises, which is inaccessible to the children and vaccination is current.
REPORT CONTINUES ON NEXT PAGE 2 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023
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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: 12/01/2023
NARRATIVE
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The licensee has proof of immunization against influenza, pertussis, and measles. Licensee's assistant, Shushanik Baghdasaryan did not have proof of immunization against Measles, Pertussis and Influenza on file.

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 08/01/23. 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, no one smokes in the home. 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 5 reviewed files.

The licensee was observed to be operating within the licensed capacity and is not exceeding the required limitations during this inspection. During this inspection 6 children were present in the facility with licensee and her assistant. All adults present have obtained a criminal record clearance on Licensing Information System (LIS). Per licensee, 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 10/25. Licensee, Nelli Sarkisyan completed required mandated reporter training on 10/28/21 which has not been renewed every 2 years as it is required. There are first aid supplies available on the premises in the living room. LPA advised licensee that if a child shows signs of illness he/she/they shall be separated from other children.

At 1:50 p.m., facility roster was reviewed and completed. Per licensee currently there are 8 children enrolled. LPA reviewed 5 children's records, including emergency information from 8 enrolled children, and all 5 reviewed files were completed.
REPORT CONTINUES ON NEXT PAGE 3 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023
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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: 12/01/2023
NARRATIVE
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INFANT CARE: Licensee states currently she has two infants enrolled in her daycare who are 23 months old and do not nap in the daycare. Licensee states that infants sleep in the living room and one daycare bedroom 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.

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

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.
The following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.
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, Nelli Sarkisyan at 3:50 p.m..
REPORT END 4 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 12/01/2023 03:56 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 12/01/2023 at 01:38 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: SARKISYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020964

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/15/2023
Section Cited
CCR
102417(g)(1)

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(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
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Per licensee, she will purchase a new fire extinguisher by 12/08/23 and a copy of receipt will be submitted to LPA via email.
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Per licensee the required 2A 10BC fire extinguisher was purchases on 01/04/2022 as read by LPA from the receipt and hasn't been serviced annually as it is required which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
12/08/2023
Section Cited
HSC1596.8662(b)(1)

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(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete etc...
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Per licensee, she will renew her required mandated reporter training by 12/08/23 and a copy will be submitted to LPA via email.
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Licensee, Nelli Sarkisyan completed required mandated reporter training on 10/28/2021 which has been expired which poses/posed a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Christina Gabelman
LICENSING EVALUATOR NAME:Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:
DATE: 12/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/01/2023 03:56 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 12/01/2023 at 01:50 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: SARKISYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020964

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/08/2023
Section Cited
HSC
1597.622(a)(1)

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(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. etc...
This requirement is not met as evidenced by:
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Per licensee, her assistant will have proof of immunization against Measles, Pertussis and Influenza by 12/08/23 and copies will be submitted to LPA via email.
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Based on staff file review, licensee's assistant did not have proof of immunization against Measles, Pertussis and Influenza on file which poses/posed a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Christina Gabelman
LICENSING EVALUATOR NAME:Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:
DATE: 12/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2023


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