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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021028
Report Date: 03/18/2024
Date Signed: 03/18/2024 03:14:52 PM

Document Has Been Signed on 03/18/2024 03:14 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: 6CENSUS: 6DATE:
03/18/2024
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Anahit Poghosyan, LicenseeTIME COMPLETED:
03:30 PM
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ANNUAL- REQUIRED INSPECTION CONDUCTED IN ARMENIAN
Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced required inspection to the above facility on 03/18/24. LPA arrived at the facility at 1:00 PM and met with Anahit Poghosyan, Licensee who guided analyst on a tour of the facility. An Office Informal Meeting was held with licensee on 11/30/23 and facility was placed on required inspection for one year. A COVID 19 risk assessment was conducted prior to entering the facility. Also present during this inspection, was Kristina Hovhannisyan, Licensee’s Assistant. Per licensee, Anahit Poghosyan facility hours are Monday to Friday from 8:00 a.m. to 5:00 p.m.. Upon LPA's arrival to the facility LPA observed six children were napping in the daycare bedroom with licensee and her assistant.

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. 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. 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 1:15 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. Next to the living room, The dining room as inspected, and
REPORT CONTINUES ON NEXT PAGE 1 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2024
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: 03/18/2024
NARRATIVE
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LPA 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. Per licensee, she installed a wall AC/heather unit in the living room and she does not use the wall heater anymore. Next LPA toured the kitchen and observed child proof safety latches on the cabinets where licensee stores sharp items and cleaning compounds. LPA observed a child safety gate was installed to the kitchen. Next LPA toured the daycare bedroom and did not observe any hazards. LPA observed six children were napping inside the daycare bedroom. Next LPA 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. LPA 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. LPA observed that the outdoor yard has toys, swings, 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. Per licensee, she keeps the backyard gate 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, Anahit Poghosyan at 2:30 PM there are no pets, weapons, firearms, pools, spas, hot tubs, fish ponds, or similar bodies of water on the premises.

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 facility with licensee and her assistant. All adults present have obtained a criminal record clearance on Licensing Information System (LIS). Per licensee, Anahit Poghosyan at 2:30 PM 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.
REPORT CONTINUES ON NEXT PAGE 2 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024
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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: 03/18/2024
NARRATIVE
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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. LPA advised licensee that if a child shows signs of illness he/she/they shall be separated from other children.

At 2:50 PM, facility roster was reviewed and was not current and completed. Per licensee currently there are 6 children enrolled. LPA reviewed 6 children's records, including emergency information from 6 enrolled children, one child out of five children did not have immunization record on file.

The licensee and her assistant proof of immunization against influenza, pertussis, and measles. Licensee's assistant, Kristina Hovhannisyan did not have TB test clearance 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 12/23/23. 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 6 reviewed files.

INFANT CARE: Licensee states that she is caring for infants over 12 months old. Per licensee, currently she has one 20 months old infant enrolled in her daycare. Licensee states infants sleep in the living room, dining 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.
REPORT CONTINUES ON NEXT PAGE 3 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024
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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: 03/18/2024
NARRATIVE
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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.

During this inspection LPA cleared Type A and B deficiencies that were cited on 09/21/23 and 10/02/23.

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, Anahit Poghosyan at 3:30 p.m..
REPORT END 4 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024
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Document Has Been Signed on 03/18/2024 03:14 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 03/18/2024 at 02:00 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: 03/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/18/2024
Section Cited
CCR
102418(a)

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Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.
This requirement is not met as evidenced by:
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Per licensee, she will obtain child#3 immunization record by plan of correction due date, 04/18/24.
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Based on six children files review, the licensee did not comply with the section cited above in LPA observed one child is missing proof of immunization which poses a potential health, safety or personal rights risk to persons in care.
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Type B
04/18/2024
Section Cited
CCR102369(b)(9)

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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:
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Per licensee, her assistant, Kristina Hovhannisyan will have TB test clearance by plan of correction due date, 04/18/24.
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Based on staff file review, licensee's assistants, Kristina Hovhannisyan did not have TB Test clearance on file which poses 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: 03/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2024


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