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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021072
Report Date: 09/01/2022
Date Signed: 09/01/2022 02:45:41 PM

Document Has Been Signed on 09/01/2022 02:45 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:GHAZARYAN & POGHOSYAN FAMILY CHILD CAREFACILITY NUMBER:
198021072
ADMINISTRATOR:SHUSHANIK GHAZARYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 877-9849
CITY:GLENDALESTATE: CAZIP CODE:
91201
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/01/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Shushanik Ghazaryan and Tigran Poghosyan, ApplicantsTIME COMPLETED:
03:00 PM
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PRELICENSING INSPECTION CONDUCTED IN ARMENIAN
Licensing Program Analyst (LPA) Anomeh Eivazian conducted an announced pre-licensing inspection to the above facility on 09/01/2022. LPA arrived at the facility at 11:40 AM and met with , Applicants Shushanik Ghazaryan and Tigran Poghosyan who guided analyst on a tour of the facility. Pre-licensing Entrance Checklist (LIC9280) was provided to applicants. During this inspection individuals who reside in the home were discussed and notes on Confidential Name List (LIC811) and attached to this report. Per applicants operation hours will be Monday to Sunday, 6:00 a.m. to 11:59 p.m.. Applicants state they will care for children 0-12 years old.

Applicants previously were licensed at 1328 Orange Grove Avenue, Glendale, CA 91205 with facility number 198020481. Fire Clearance for Large Family Child Care was granted on 08/30/2022. Fire clearance was also granted to use the detached converted garage for limited activity only, children can not eat or sleep inside the detached converted garage.
All areas identified on the facility sketch were inspected. This is a one story home located on the first level. The home consists of 3 bedrooms, 1 restroom, living room, kitchen, detached converted garage (daycare limited activity area) which consists of a room and one half bathroom, detached storage in the backyard, front yard, and backyard (fenced). There is a fireplace in the living room which has been blocked off to prevent access to children. Per applicants, parents will enter the home through the side gate which leads to the back yard and daycare bedroom.
Areas that are accessible to children are as follows: Bathroom in the hallway, one bedroom adjacent to the kitchen, detached converted garage (for limited activity only), half bathroom in the detached converted garage, and front part of backyard (fenced).
Areas off limits based on facility sketch submitted to children and parents include: Living room, kitchen, two bedrooms, detached storage in the backyard, front yard, and back of backyard.
**Rooms that are off-limits need to be made inaccessible during operating hours**
REPORT CONTINUES ON NEXT PAGE 1 of 5
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/01/2022
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: GHAZARYAN & POGHOSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021072
VISIT DATE: 09/01/2022
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Per applicants, they will serve children (0-12 years old). Per applicants, based on children's age group, they will use the detached converted garage for limited activity only. Each age group will not use the detached converted garage more than 3 hours per day. Per applicants, children will eat outside and in the daycare bedroom and sleep inside the home in the daycare bedroom. A written declaration obtained from applicants regarding they plan to use the detached converted garage for limited activity only.

At 12:10 pm, the applicants began touring LPA’s through the home starting with the entry way which lead directly to the off-limit living room. The living room was inspected and LPA observed fireplace was screened to prevent access. Next LPA toured the two off-limit bedrooms and off-limit kitchen and did not observe any hazards. Next LPA toured the one bathroom and observed child proof safety latches on the cabinet under the sink where applicants store cleaning compounds. Next LPA toured the one daycare bedroom adjacent to the kitchen and observed children tables, chairs and napping cots in the daycare bedroom. There is a door in the daycare bedroom which leads to the backyard. Per applicants, they will keep the off limit bedrooms and kitchen doors closed all the times during daycare hours. Per applicants, no poisons are kept in the apartment. LPA observed the required 2A 10BC fire extinguisher was anchored to the wall in the daycare bedroom inside the home and detached converted garage. Both were purchased on 08/15/2022 as read by LPA from the receipt. Applicants tested the carbon monoxide and smoke detectors in the daycare bedroom and detached converted garage. 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 detached converted garage (limited activity area) and observed children toys, chairs and table in the detached converted garage. LPA observed a sink and half bathroom in detached converted garage. LPA informed applicants, detached converted garage can only be used for limited activity only. Children can not eat or sleep inside the detached garage.

Next LPA toured the backyard fenced. Per applicants, children will use the front area of back yard for outdoor play time. Backyard off-limit areas are separated by vinyl gates 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 outdoor playarea ground is artificial grass. The applicants state that supervision is always provided. (LPA obtained a declaration). The applicant does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.
REPORT CONTINUES ON NEXT PAGE 2 of 5
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022
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: GHAZARYAN & POGHOSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021072
VISIT DATE: 09/01/2022
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The applicants state that they will provide food for children in care. Applicants were 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 applicants, at 1:30 p.m. there are no pets, weapons, firearms or bodies of water on the premises. There are toys available for children. There is telephone service via a cellphone that is used and the cellphone stays at the facility during operation hours. LPA advised applicant that if a child shows signs of illness he/she/they shall be separated from other children. Per applicants, no one smokes in the home. There are first aid kits in the home, in the the kitchen and daycare bedroom.

Applicants have proof of CPR and First Aid training as indicated on the certificate. The applicants have proof of Health and Safety training (completion date: 08/20/2022), Shushanik Ghazaryan Pediatric First Aid and CPR (ex. 11/22) and Tigran Poghosyan Pediatric First Aid and CPR (ex. 06/23). Both applicants have proof of immunization against influenza, pertussis, and measles.
Both Applicants completed required mandated reporter training on 07/20/2022. Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com
The following was discussed with the applicant:
Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

-In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.


-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.
-Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License shall be terminated.
-The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should check and batteries replaced as needed.
REPORT CONTINUES ON NEXT PAGE 3 of 5
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: GHAZARYAN & POGHOSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021072
VISIT DATE: 09/01/2022
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-Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
-Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report)
-Fire and safety drills must be performed every six months and documented for review by the Department.
-Smoking is prohibited in a family child care home.
-Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
-Dog(s) and or pets are recommended to be isolated from children in care.
-No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.
-All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
- Applicant shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.
- Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.

INFANT CARE: Applicants state that they will care for infants. Applicants state that infants will sleep in the daycare bedroom inside the home where they are constantly be supervised. Appropriate sleeping arrangements and cribs will be available once an infant being enrolled. LPA informed one crib for each infant in care will be needed. Cribs or play yard shall not hinder the entrance or exit from the sleeping space, mattresses shall be firm and covered with a fitted sheet that overlaps the underside so it cannot be dislodged. Cribs and play yards shall be free of loose articles and objects. No objects shall be hanging above or attached to the side of the crib. LPA informed Applicants infants can not be swaddled while in care. LPA advised the Applicants 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 Applicant. LPA provided the Applicant 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.
REPORT CONTINUES ON NEXT PAGE 4 of 5
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: GHAZARYAN & POGHOSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021072
VISIT DATE: 09/01/2022
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SAFE SLEEP: LPA discussed the safe sleep regulations with applicants and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
Medication: Incidental Medical Services (IMS) policy was discussed .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
Per applicants, there are no dual licenses at this address. Applicant’s email address was obtained during this inspection. The applicants were advised that email may be public information. Per applicants, carries liability insurance or a bond in accordance with standard established by Family Child Care statue. The law requires Family Child Care provider to carry liability insurance or bond in the amount of $300,000 annually or to maintain the signed statement in the facility file.
Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.
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.
A large family child care license will be granted upon receipt of proof of corrections for the above. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license.
The applicant’s signature on this report acknowledges that they have signed the Application for a Family Child Care Home License (LIC 279) under the penalty of perjury that the statements on the application and any attachments are correct.
Exit interview conducted and report was reviewed with the applicants, Shushanik Ghazaryan and Tigran Poghosyan at 3:00 p.m..
REPORT END 5 of 5
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022
LIC809 (FAS) - (06/04)
Page: 5 of 5