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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021028
Report Date: 09/21/2023
Date Signed: 09/21/2023 04:45:43 PM

Document Has Been Signed on 09/21/2023 04:45 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:POGHOSYAN FAMILY CHILD CAREFACILITY NUMBER:
198021028
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
09/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Anahit Poghosyan, LicenseeTIME COMPLETED:
05:00 PM
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REQUIRED- 1 YEAR INSPECTION CONDUCTED IN ARMENIAN
Licensing Program Analysts (LPA) Anomeh Eivazian and Sushanik Safaryan conducted an unannounced required 1- year inspection and capacity increase inspection to the above facility on 09/21/23 due to licensee is requesting capacity increase. LPAs arrived at the facility at 1:25 PM, LPAs heard lullaby was playing inside the home, did not rang the bell, knocked on the door couple times, no one opened the door. LPA Eivazian contacted licensee's phone number on the file at (818) 930-2616 at 1:28 PM, 1:35PM, 1:36 PM, 1:39 PM, 1:45 PM no one answered the phone. LPAs Eivazian and Safaryan heard lullaby was turned off. LPA Eivazian knocked on the door stated in Armenian, please open the door, we are from licensing, if Licensee is not at home that is fine, we heard lullaby was on and then it was turned off. At 2:00 PM when LPA Safaryan came by the corner of Allen Avenue and Glenwood RD, observed a car was parked by the side gate which leads to the backyard and a woman was by the open car door. LPA Eivazian walked towards the side gate and licensee came out the car and stated she was coming from a Doctor appointment. Per licensee, her daughter Marine Topchyan and her grandson just dropped her off. Per licensee, she left the home at 12:30 PM for a doctor appointment.

Upon LPAs arrival inside the home LPAs observed 8 children inside the home, two being infants with licensee's assistant Lusine Virabyan. The licensee was observed not to be operating within the licensed capacity and is exceeding the required limitations with two children during this inspection.

At 2:00 PM, Licensee guided analyst on a tour of the facility. Per licensee, Anahit Poghosyan stated facility hours are Monday to Friday from 8:00 a.m. to 5:00 p.m. LPA provided a copy of Entrance Checklist—Family Child Care Home (LIC126) to licensee.
Fire clearance for large family child care home was granted on 09/15/23.
REPORT CONTINUES ON NEXT PAGE 1 of 5
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2023
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: POGHOSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021028
VISIT DATE: 09/21/2023
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 This is a one story home located on the first level. The home consists of 2 bedrooms, 1 restroom, living room, dining room, kitchen, laundry room, front yard, and backyard (fenced). Per licensee, the children use the bathroom in the hallway, living room, dining room, kitchen, laundry room, one bedroom, and backyard (fenced). Per licensee areas off limits to children and parents include: One bedroom, and front yard. LPAs 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. Per licensee, parents enter the facility through the main entrance which leads to the living room.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. At 2:10 p.m., 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 observed to be covered. LPA observed six high chairs in the living room. There is a fireplace in the living room which has been blocked off to prevent access. Upon LPAs arrival LPA observed four children napping cots in the living room and four children were napping in the living room. Next to the living room, The dining room as inspected, and LPAs observed children tables and chairs in the dining room. There are wall heaters in the dining room and bedrooms hallway which have not been blocked off to prevent access. However per licensee, she just installed a wall AC/heather unit in the living room and will not use wall heater anymore. Next LPAs toured the kitchen and observed child proof safety latches on the cabinets where licensee stores sharp items and cleaning compounds. LPAs observed a child safety gate was installed to the kitchen. Next LPA toured the daycare bedroom and did not observe any hazards. LPAs observed four children were napping inside the daycare bedroom. Next LPAs toured the off-limit one bedroom and observed licensee's personal belongings in the home. Next LPA toured the one bathroom and did not observe any hazards. Per licensee, children walk through the kitchen and laundry room to go to the backyard (fenced). Per licensee, there is no poisons kept in the home. LPAs observed the required 2A 10BC fire extinguisher was anchored to the wall in laundry room. It was serviced on 09/14/23 as read by LPA from service tag. Licensee tested the carbon monoxide and smoke detectors in the hallway of bedrooms. It 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 back yard for outdoor play time. The outdoor play area was observed to be fenced. LPAs 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.
REPORT CONTINUES ON NEXT PAGE 2 of 5
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023
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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: POGHOSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021028
VISIT DATE: 09/21/2023
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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, Anahit Poghosyan at 3:15 AM there are no pets, weapons, firearms, pools, spas, hot tubs, fish ponds, or similar bodies of water on the premises.

All adults present have obtained a criminal record clearance on Licensing Information System (LIS). Per licensee, Anahit Poghosyan at 3:20 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 04/2024. Licensee, Anahit Poghosyan is exempt from required mandated reporter due to language barrier. Per licensee, she is an Armenian speaking provider. LPAs advised licensee that if a child shows signs of illness he/she/they shall be separated from other children.

At 3:00 PM, facility roster was reviewed and was not current and completed. Per licensee currently there are 8 children enrolled. LPAs reviewed 5 children's records, including emergency information from 8 enrolled children, and all 8 reviewed files were completed. Licensee was missing 3 children files during this inspection.

The licensee and her assistant have proof of immunization against influenza, pertussis, and measles.
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 06/12/23. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted at the wall by the entrance.

LPAs 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.
REPORT CONTINUES ON NEXT PAGE 3 of 5
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023
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: POGHOSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021028
VISIT DATE: 09/21/2023
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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.

INFANT CARE: Licensee states that she is caring for infants over 12 months old. Licensee states infants sleep in the living room, dining room and one daycare bedroom where they are constantly supervised. Per licensee, currently there are two infants enrolled in her daycare who are over 12 months old. 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.

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

DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023
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: POGHOSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021028
VISIT DATE: 09/21/2023
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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.

LPA Eivazian informed licensee, Anahit Poghosyan that this report dated 09/21/23 documents 1 Type A citation. Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Eivazian informed the licensee, Anahit Poghosyan to provide a copy of this licensing report dated 09/21/23 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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, Anahit Poghosyan 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, Anahit Poghosyan, 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, Anahit Poghosyan at 5:00 p.m..
REPORT END 5 of 5
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023
LIC809 (FAS) - (06/04)
Page: 5 of 7
Document Has Been Signed on 09/21/2023 04:45 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 09/21/2023 at 03:54 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: POGHOSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021028

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(b)(3)
Staffing Ratio and Capacity
(b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: (3) More than six and up to eight children, without an additional adult attendant, only if the criteria in
Section 1597.44 of the Health and Safety Code are met.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observation, the licensee did not comply with the section cited above, upon LPAs arrival to the facility on 09/21/23 there were total of 8 children present in the home, 2 being infants with licensee's assistant only which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/22/2023
Plan of Correction
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Per Licensee, effective 09/22/23 she will disenroll two children from her daycare and an updated facility roster will be submitted to LPA. A written declaration will be submitted to LPA by 09/21/23.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: 09/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2023


LIC809 (FAS) - (06/04)
Page: 6 of 7
Document Has Been Signed on 09/21/2023 04:45 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 09/21/2023 at 03:54 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: POGHOSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021028

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102421(a)
Child's Records
(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on children file review, the licensee did not comply with the section cited above and from 8 enrolled and present children only 5 children files were available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/29/2023
Plan of Correction
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Per licensee, she will have all present children files available for review by plan of correction due date 09/29/23.
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on facility file review , the licensee did not comply with the section cited above and licensee did not have current facility roster available during this inspection for review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/29/2023
Plan of Correction
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Per licensee, she will have current facility roster available for review by 09/29/23.
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: 09/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2023


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