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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021085
Report Date: 04/03/2024
Date Signed: 04/03/2024 11:18:47 AM

Document Has Been Signed on 04/03/2024 11:18 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:KHACHATRYAN FAMILY CHILD CAREFACILITY NUMBER:
198021085
ADMINISTRATOR:
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 3CENSUS: 0DATE:
04/03/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
TIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Susanna Khachatryan, LicenseeTIME COMPLETED:
TIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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CASE- MANAGEMENT INSPECTION CONDUCTED IN ARMENIAN
Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced case- management inspection to the above facility on 04/03/24 due to licensee is requesting capacity increase. LPA arrived at the facility at 8:40 AM and met with Susanna Khachatryan, Licensee who guided analyst on a tour of the facility. A COVID 19 risk assessment was conducted prior to entering the facility. Per licensee, Susanna Khachatryan facility hours are Monday to Saturday from 7:00 a.m. to 12:00 a.m.

Fire Clearance for Large Family Child Care was granted on 03/14/24.

All areas identified on the facility sketch were inspected. This is a two story house located on the second level. The home consists of 3 bedrooms, 2 restrooms, living room, kitchen, laundry room adjacent to the bedroom in the first floor, guest house in the back of the home on the third level, garage, front yard, and backyard (fenced). There is a pool on the premises, located on the third level of the backyard. Per licensee, parent enter the facility by using the front yard stairs by the wall which leads to the main entrance door and living room.

Pool Area (off-limit) is located on the third level in the backyard. Pool is surrounded on three sides by 6 feet high cement and wooded walls and on one side with 4 feet high mesh fence that gate swings away from body's of water, self-closed and have a self-latching device located no more than six inches from the top of the gate. Also, on the second level of backyard, prior to the pool area, there is 6 feet high and higher cement and wooden walls to make the pool area inaccessible to the children. The fence meets Title 22 Regulations requirements.

Per licensee the children use the bathroom in the first floor bedroom, bedroom in the first floor, living room (main daycare area), and backyard (fenced) adjacent to the kitchen and living room.
REPORT CONTINUES ON NEXT PAGE 1 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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: KHACHATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021085
VISIT DATE: 04/03/2024
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Per licensee areas off limits to children and parents include: Entire second floor which consists of two bedrooms, one bathroom, laundry room adjacent to the bedroom in the first floor, kitchen, front yard, garage, guest house, second and third level of the backyard, and Pool area which is located in the third level of the backyard. **Rooms that are off-limits need to be made inaccessible during operating hours**

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. At 9:00 a.m., Licensee took this LPA on a tour of the home. LPA was toured through the interior starting with the living room (daycare area). The living room was inspected and electrical outlets were observed to be covered. There is a fireplace in the living room which has been blocked off to prevent access to children. LPA observed children toys in the living room. LPA observed a safety gate was installed in the living room to make the kitchen inaccessible. LPA observed a child safety gate was installed to the stairs in the living room which leads to the second floor to make the second floor inaccessible to the children. Next LPA toured the off-limit kitchen and observed a sofa, and a coffee table in the kitchen. LPA observed child proof safety latches on the cabinets where licensee stores sharp items and cleaning compounds. Next LPA toured the one bedroom and one bathroom in the first floor and did not observe any hazards. LPA observed a safety gate was installed in the bedroom to make the laundry room inaccessible. LPA observed licensee's family members personal belongings in the home. Next LPA toured the laundry room adjacent to the first floor bedroom and did not observe any hazards. Per licensee, no poisons are kept in the home. LPA observed the required 2A 10BC fire extinguisher was anchored to the wall in the living room. It was serviced on 11/15/23 as read by LPA from service tag. Licensee tested the carbon monoxide and smoke detectors in the living room. 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. Currently, children are using the back yard for outdoor play time. Per licensee, children use the living room door to enter the backyard. The outdoor play area was observed to be fenced. LPA observed 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. LPA observed a child safety gate was installed to the stairs in the backyard to make the second and third level of backyard inaccessible to the children. LPA observed the side gate in the backyard has chain lock out of reach of children.


REPORT CONTINUES ON NEXT PAGE 2 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: KHACHATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021085
VISIT DATE: 04/03/2024
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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, at 10:10 a.m there are no pets, weapons, and firearms on the premises.

The licensee was observed to be operating within the licensed capacity and is not exceeding the required limitations during this inspection. Per licensee, currently she has one after school child enrolled in her daycare. All adults present have obtained a criminal record clearance on Licensing Information System (LIS). Per licensee, 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 03/2026. Licensee, Susanna Khachatryan completed required mandated reporter training on 05/05/2022. There are first aid supplies available on the premises in the first floor bathroom. LPA advised licensee that if a child shows signs of illness he/she/they shall be separated from other children.

At 10:20 a.m., facility roster was reviewed and completed. Per licensee currently there is one after-school child enrolled. LPA reviewed one child's record, including emergency information and it was completed.

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 03/14/24. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted at the wall by the entrance in the living room. Per licensee, she provides transportation to the children.

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, her husband and son smoke but outside in the off-limit areas. 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 one reviewed file.
REPORT CONTINUES ON NEXT PAGE 3 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: KHACHATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021085
VISIT DATE: 04/03/2024
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INFANT CARE: Licensee states that currently she does not have any infants enrolled in her daycare. Licensee states that if an infant is enrolled, the infant will sleep in the first floor 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.

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.

LPA advised the licensee to access forms, regulations and quarterly updates online at: www.ccld.ca.gov.
At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today from the areas that were inspected today.

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, Susanna Khachatryan at 11:30 a.m..
REPORT END 4 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4