<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021003
Report Date: 07/10/2023
Date Signed: 07/10/2023 02:43:21 PM

Document Has Been Signed on 07/10/2023 02:43 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:PERIKHANYAN FAMILY CHILD CAREFACILITY NUMBER:
198021003
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 6DATE:
07/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Hasmik Perikhanyan, LicenseeTIME COMPLETED:
03:00 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
REQUIRED- 1 YEAR & CASE- MANAGEMENT INSPECTIONS CONDUCTED IN ARMENIAN
Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced required 1- year and case- management licensee initiated inspections to the above facility on 07/10/23 due to licensee is requesting capacity increase. LPA arrived at the facility at 12:10 PM and met with Hasmik Perikhanyan, 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 Lusine Soghomonyan, Licensee’s Assistant. Per licensee, facility hours are Monday to Friday from 8:00 a.m. to 6:00 p.m. LPA provided a copy of Entrance Checklist—Family Child Care Home (LIC126) to licensee.

Fire clearance for Large Family Child Care was granted on 06/14/23.

This is a one story home located on the first level. The home consists of 4 bedrooms, 2 restrooms, living room (fireplace inaccessible) , dining room, kitchen, front yard, backyard (fenced) and detached garage. There is a detached unit in the backyard which has separated address, 823 B Windsor Road, Glendale, CA 91205. Per licensee, parents enter the home through the side gate which leads to the backyard and daycare room.

Per licensee at 12:15 PM, the children use the bathroom in the hallway of kitchen, living room, dining room, one bedroom adjacent to the living. Per licensee areas off limits to children and parents include: Two bedrooms, one bathroom in the hallway of bedrooms, front yard, back of back yard and detached garage. LPA did not observe any 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 12:20 pm, the licensee began touring LPA’s through the home starting with the
REPORT CONTINUES ON NEXT PAGE 1 of 5
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 07/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/10/2023
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 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: PERIKHANYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021003
VISIT DATE: 07/10/2023
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
26
27
28
29
30
31
32
entry way which lead directly to the living room and dining room. The living room and dining room were inspected and electrical outlets were observed to be covered. LPA observed sofas, a coffee table, a TV, an adult dining table and chairs in the dining room and living room. There is Fireplace in living room which has been blocked off to prevent access. Per licensee, children walk through the living room and dining room to go to the daycare main bedroom. Next LPA toured the daycare one bedroom adjacent to the main entrance and observed a bed and napping cots. Next LPA toured the kitchen and observed child proof safety latches on the cabinets where licensee stores sharp items and cleaning compounds. Next LPA toured the childcare bathroom in the hallway of kitchen and did not observed any hazards. Next LPA toured the daycare bedroom (main daycare area) and observed children toys, tables and chairs in the daycare room. There is a door in the daycare bedroom which leads to the backyard. Next LPA toured the off-limit two bedrooms and bathroom and did not observed any hazards. Per licensee there is no poison in the home. LPA observed the required 2A 10BC fire extinguisher was anchored to the wall in the hallway of kitchen. It was serviced on 12/10/22 as read by LPA from the service tag. Licensee tested the carbon monoxide and smoke detectors in the daycare playarea. 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 front part of backyard for outdoor play time which is gated and separated from off limit areas. The outdoor play area was observed to be fenced. 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. The outdoor playarea ground is covered with outdoor green carpet.

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, at 1:00 p.m there are no pets, pools, spas, hot tubs, fish ponds, or similar bodies of water on the premises. Per licensee, at 1:10 p.m., at 9:30 am, there are two fire arms in the home. LPA observed the fire arms are stored in off-limit area and firing pins were removed. Ammunition were locked separately in off-limit area.

REPORT CONTINUES ON NEXT PAGE 2 of 5
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2023
LIC809 (FAS) - (06/04)
Page: 2 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: PERIKHANYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021003
VISIT DATE: 07/10/2023
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
26
27
28
29
30
31
32
The licensee was observed to be operating within the licensed capacity and is not exceeding the required limitations during this inspection. During this inspection six children were present in the daycare room, one being infant with licensee and her one assistant. All adults present have obtained a criminal record clearance on Licensing Information System (LIS). Per licensee, 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.

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 01/2024. Licensee, Hasmik Perikhanyan completed required mandated reporter training on 02/02/2022. There are first aid supplies available on the premises in the laundry area. LPA advised licensee that if a child shows signs of illness he/she/they shall be separated from other children.

At 1:30 p.m., facility roster was reviewed and completed. Per licensee currently there are 6 children enrolled. LPA reviewed 6 children's records, including emergency information from 6 enrolled children, and all 6 reviewed files were completed.

The licensee has proof of immunization against influenza, pertussis, and measles. During this inspection licensee's assistant, Lusine Soghomonyan did not have TB test clearance and proof of immunization against pertussis, measles 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 07/07/23. 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 carries liability insurance in accordance with standard established by Family Child Care statue.
REPORT CONTINUES ON NEXT PAGE 3 of 5
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2023
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: PERIKHANYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021003
VISIT DATE: 07/10/2023
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
26
27
28
29
30
31
32
INFANT CARE: Licensee states that she is provides care to infants 12 months and older. Per licensee, currently she has one infant enrolled in her daycre. Licensee states that infants sleep in the daycare areas where they are constantly supervised. LPA did not observe any infants swaddled while in care. 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. LPA provided the licensee 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.

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.
REPORT CONTINUES ON NEXT PAGE 4 of 5
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2023
LIC809 (FAS) - (06/04)
Page: 4 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: PERIKHANYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021003
VISIT DATE: 07/10/2023
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
26
27
28
29
30
31
32
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.

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, Hasmik Perikhanyan 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, Hasmik Perikhanyan, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Exit interview conducted and report was reviewed with the Licensee, Hasmik Perikhanyan at 3:00 p.m..
REPORT END 5 of 5
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2023
LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 07/10/2023 02:43 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 07/10/2023 at 01:41 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: PERIKHANYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021003

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/10/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(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. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on staff file review, the licensee did not comply with the section cited above and licensee's assistant, Lusine Soghomonyan did not have proof of immunization against influenza, pertussis and measles on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/10/2023
Plan of Correction
1
2
3
4
Per licensee, her assistant will complete required immunization and copies will be submitted to LPA by 08/10/23 via email.
Type B
Section Cited
CCR
102369(b)(9)
application for initial license
Evidence of a current tuberculosis clearance, not more than one year prior to or seven days after initial presence in the home, for any adult in the home during the time that children are under care.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on staff interview, the licensee did not comply with the section cited above and licensee's assistant, Lusine Soghomonyan did not have TB tet clearance on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/10/2023
Plan of Correction
1
2
3
4
Per licensee, her assistant will complete the required TB test and a copy will be submitted to LPA via email by 08/10/23.
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: 07/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/10/2023


LIC809 (FAS) - (06/04)
Page: 6 of 6