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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021028
Report Date: 10/02/2023
Date Signed: 10/02/2023 03:09:39 PM

Document Has Been Signed on 10/02/2023 03:09 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: 12CENSUS: 12DATE:
10/02/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Anahit Poghosyan, LicenseeTIME COMPLETED:
03:20 PM
NARRATIVE
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PLAN OF CORRECTION INSPECTION CONDUCTED IN ARMENIAN

Licensing Program Analysts (LPA) Anomeh Eivazian conducted an unannounced Plan of Correction inspection to the above facility on 10/02/23 at 12:15 PM due to Type A and B deficiencies that were issued on 09/21/23.

Upon LPA's arrival to the facility LPA met with Anahit Poghosyan, Licensee who guided analyst on a tour of the facility. Also, during this inspection Lusine Virabyan, licensee's assistant was present in the home. During this inspection licensee's daughter Marine Topchyan stopped by the address from 2:00 PM to 2:30 PM who wanted to ensure what is happening in her mother's daycare. LPA informed Licensee that she is required to transfer her daughter's fingerprint under her facility if her daughter visits her more often during facility operation hours.

Upon LPA's arrival to the facility at 12:15 PM, LPA observed 12 children were present in the home playing in the living room, two children being infants (12 months to 24 months old), two children being three years old and eight children being two years old (24-36 months old). The licensee was observed not to be operating within the licensed capacity and is exceeding the required limitations with six children during this inspection. From 12:15 PM to 12:55 PM six children were picked up.

Per licensee, Anahit Poghosyan at 12:45 PM, she did not have present seven children files available for review.

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.
REPORT CONTINUES ON NEXT PAGE 1 of 2
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2023
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: POGHOSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021028
VISIT DATE: 10/02/2023
NARRATIVE
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Per licensee, Anahit Poghosyan at 1:21 PM, she did not have current facility roster available for review.

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 10/02/23 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 10/02/23 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.

Exit interview conducted and report was reviewed with the Licensee, Anahit Poghosyan at 3:20 p.m..


REPORT END 2 of 2
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 10/02/2023 03:09 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 10/02/2023 at 01:22 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: 10/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/03/2023
Section Cited
CCR
102416.5(a)

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(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.

This requirement is not met as evidenced by:
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Per licensee, she will drop off 6 children and only will provide care to 6 children at a one time. An updated facility roster will be submitted to LPA Eivazian by 10/03/23.
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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.
This poses an immediate health, safety, and personal right risk to the children 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: 10/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/02/2023


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 10/02/2023 03:09 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 10/02/2023 at 01:32 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: 10/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/13/2023
Section Cited
CCR
102421(a)

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(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:
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Per licensee, she will ensure to have all enrolled children files available for review by 10/13/23.
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During this inspection 12 children were present and licensee only had five children files available for review. Seven children files were not available for review during this inspection.
This poses a potential health, safety and personal right risk to the children in care.
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Type B
10/13/2023
Section Cited
CCR102417(g)(8)

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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:
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Per licensee, she will have her facility current roster available for review by 10/13/23.
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During this inspection facility roster was not available for review.
This poses a potential health, safety and personal right to the children 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: 10/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/02/2023


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 10/02/2023 03:09 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 10/02/2023 at 02:12 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: 10/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/13/2023
Section Cited
HSC
1596.8595(c)(1)

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(c)(1) A licensed child day care facility shall provide to the parents or guardians of each child receiving services in the facility copies of any licensing report that documents any Type A citation , etc...
This poses a potential health, safety and personal right risk to the children in care.
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Per licensee, she will provide a copy of 09/21/23 licensing report to all current parents and LIC 9224 will be placed in children files.

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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: 10/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/02/2023


LIC809 (FAS) - (06/04)
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