198021028-11-30-2023-33-CC-AEIN-CY3QH8-20231130111044

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198021028
Report Date: 11/30/2023
Date Signed: 11/30/2023 11:10:51 AM

Document Has Been Signed on 11/30/2023 11:10 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:	POGHOSYAN FAMILY CHILD CARE		FACILITY NUMBER:	198021028
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	11/30/2023
TYPE OF VISIT:	Office	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Anahit Poghosyan, Licensee		TIME COMPLETED:	11:00 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	An informal office meeting was conducted on 11/30/2023 at 10:00 AM at the Monterey Park Regional Office. Present during the meeting were Licensing Program Manager (LPM) Christina Gabelman, Licensing Program Analysts (LPA) Anomeh Eivazian and Suzana Safaryan and Licensee, Anahit Poghosyan and licensee's friend, Lida Manukyan. This meeting was translated in Armenian by LPA Eivazian. The purpose of this Informal Meeting is to discuss the history of the facility and pending capacity increase application. The summary of history includes 2 Type A and 5 Type B’s deficiencies from 2022-2023: Deficiencies include: On 10/02/2023—Type A—102416.5(A)—Staffing Ratio and Capacity -- Upon LPA's arrival to the facility at 12:15 PM on 10/02/23, 12 children were present in the home with licensee and her assistant, all 12 children were under four years old. On 09/21/2023-- Type A—102416.5(b)(3)— Staffing Ratio and Capacity. Upon LPAs arrival at the facility on 09/21/23, there were total of 8 children present in the home, 2 being infants with licensee's assistant. On 10/02/2023—Type B—H&S Code: 1596.8596(c )(1)-- Posting licensing report by child care facility or home; duration of posting; civil penalty for failure to comply; reports to be provided to parents or guardian of each child receiving services -- Per licensee, she did not provide to all enrolled parents a copy Annual Report dated 09/21/23 which contains a Type A citation and licensee did not have Acknowledgement of Receipt of Licensing Report (LIC 9224) for 09/21/23 inspection signed on children files available for review. LPA only observed two LIC 9224 signed and dated for 09/21/23 report available for review. On 09/21/2023 and 10/02/2023—Type B—102421(a)—Child’s Record-- During these inspections present children files were not available for review. REPORT CONTINUES ON NEXT PAGE 1 of 3

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023

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: 11/30/2023

NARRATIVE

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On 09/21/2023 & 10/02/2023—Type B—102417(g)(8)—Operation of Family Child Care Home--During these inspections facility roster was not available for review.

On 09/21/23, 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.

LPM Gabelman reviewed Title 22 Regulations- Inspection Authority of the Department—102391(a)-- Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation of, the regulations adopted by the Department governing family child care homes, and in accordance with Section 102396.

Title 22 Regulations—102417(a)--Operation of a Family Child Care Home--The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

LPM Gabelman informed the licensee that during her absence from the facility during facility operation hours she is required to have qualified assistants present in the home and meet the Staffing and Ratio requirements at all the times. Also, LPM Gabelman advised licensee to train her staff to open the facility door for licensing staff during her absence.

REPORT CONTINUES ON NEXT PAGE 2 of 3

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: 11/30/2023

NARRATIVE

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LPA Eivazian advised licensee, 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.

The licensee has agreed to the following to ensure compliance:
1. The facility must be in compliance at all times.
2. The facility will be placed on required visits for one year and an LPA will conduct inspection quarterly.
3. The Licensee was advised that it is the responsibility of the Licensee to know & understand the requirements of Title 22 Regulations.
4. The Licensee will also be required to view the following videos on the Department website https://ccld.childcarevideos.org/:
. Record Keeping in Family Child Care Home
. How many Children can attend a Family Child Care Home
. Supervising Children in Family Child Care Home
. CCL Inspection Authority
5. Licensee will submit facility updated roster
6. During this inspection the Licensee agreed to withdraw her pending capacity increase application at this time and reapply after a year from this meeting date. A written declaration was obtained from the licensee regarding her application withdrawal.

The Licensee shall submit a written statement to the Department on what she learned from each video no later than 01/05/2024.

Licensee was advised if facility is not being met with Title 22 Regulation during the compliance period, Licensee may be called in for Non-Compliance Meeting sooner.

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.

Please visit the Child Care Licensing website at: www.ccld.ca.gov for quarterly updates, forms and regulations.

Exit interview conducted with Licensee, Anahit Poghosyan who is agreement with the above.

REPORT END 3 of 3

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023

LIC809 (FAS) - (06/04)

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