198021096-10-3-2022-33-CC-AEIN-CJUQEW-20221003120701

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198021096
Report Date: 10/03/2022
Date Signed: 10/03/2022 12:07:09 PM

Document Has Been Signed on 10/03/2022 12:07 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:	SARGSYAN FAMILY CHILD CARE		FACILITY NUMBER:	198021096
ADMINISTRATOR:	OFELYA SARGSYAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 406-0306
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	10/03/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Ofelya Sargsyan, Applicant		TIME COMPLETED:	12:30 PM

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	PRELICENSING INSPECTION CONDUCTED IN ARMENIAN Licensing Program Analyst (LPA) Anomeh Eivazian conducted an announced pre-licensing inspection to the above facility on 10/03/2022. LPA arrived at the facility at 10:00 AM and met with Ofelya Sargsyan, Applicant who guided analyst on a tour of the facility. Pre-licensing Entrance Checklist (LIC9280) was provided to applicant, Ofelya Sargsyan. During this inspection individuals who reside in the home were discussed and notes on Confidential Name List (LIC811) and attached to this report. Per applicant operation hours will be Monday to Sunday, 4:00 a.m. to 11:00 p.m.. Applicant states she will care for children 0-12 years old. Applicant was previously licensed at 1217 E. Windsor Road, Glendale, CA 91205 with facility number 198019143. Fire clearance for large family child care home was granted 09/26/2022. 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, 2 restrooms, living room, dining room, kitchen, detached converted garage (limited activity space), front yard and backyard (fenced). Per applicant, parents will enter the facility through the main entrance which leads to the living room and side gate which leads to the backyard. Areas that are accessible to children are as follows: Two bedrooms adjacent to the living room, bathroom inside the bedroom, living room, dining room, kitchen, detached converted garage for limited activity only, and backyard (fenced). Areas off limits based on facility sketch submitted to children and parents include: Mater bedroom, bathroom in master bedroom, and front yard. Rooms that are off-limits need to be made inaccessible during operating hours Per applicant, children will use the detached converted garage for limited activity only. LPA informed applicant that children can not eat and sleep inside the detached converted garage. Per applicant, children either will eat outside or inside the home and sleep inside the home. Per applicant, children will use the detached converted garage for limited activity only, daily from 10:00 a.m. to 12:00 p.m. and 2:30 p.m. to 4:00 p.m.. A written declaration obtained from applicant. The applicant does understand that licensing staff may have access to off-limit areas during inspection visit if necessary. REPORT CONTINUES ON NEXT PAGE 1 of 5

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022

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: SARGSYAN FAMILY CHILD CARE	FACILITY NUMBER: 198021096
	VISIT DATE: 10/03/2022

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At 10:25 am, the applicant began touring LPA’s through the home starting with the entry way which lead directly to the living room and dining room The living room and dining room were inspected and electrical outlets were observed to be covered. There is a decorative fireplace in the living room which has been blocked off to prevent access. LPA observed sofas, a coffee table, a dining table and chairs in the living room and dining room. Next to the living room, The kitchen was inspected, and LPA observed safety latches on the cabinet where applicant stores cleaning compounds and sharp items. Next LPA toured the one daycare bedroom and observed children tables, chairs, napping cots and two pack n' plays in the daycare bedroom. Next LPA toured the second daycare bedroom and observed a full size bed in the bedroom. Next LPA toured the daycare bathroom in the bedroom and observed child proof safety latch on the cabinet under the sink. Next LPA toured the off-limit master bedroom and bathroom in the master bedroom and did not observe any hazards. LPA observed applicant's family members personal belongings in the home. Per applicant, poisons are kept in the storage in the backyard which is locked. LPA observed the required 2A 10BC fire extinguisher was anchored to the in the kitchen. It was serviced on 08/18/2022 as read by LPA from the service tag. Applicant tested the carbon monoxide detector in the hallway of bedrooms and and smoke detector in the bedrooms. 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 backyard fenced. Per applicant, children will 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 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 cement and artificial grass. The applicant states that supervision is always provided.

The applicant states that they will provide food for children in care. Applicant 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 applicant, at 11:30 am, there are no pets or bodies of water on the premises. There are four fire arms in the home. LPA observed the fire arms are stored in off-limit area and firing pins were removed. Ammunition were locked separately in off-limit area. 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 applicant no one smokes in the home. There are first aid kit in the home, in the kitchen.
REPORT CONTINUES ON NEXT PAGE 2 of 5

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022

LIC809 (FAS) - (06/04)

Page: 2 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: SARGSYAN FAMILY CHILD CARE	FACILITY NUMBER: 198021096
	VISIT DATE: 10/03/2022

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Applicant has proof of CPR and First Aid training as indicated on the certificate. The applicant does have proof of Health and Safety training (completion date: 02/05/2022), Pediatric First Aid and CPR (ex. 10/01/2023). The applicant has proof of immunization against influenza, pertussis, and measles.
Applicant completed required mandated reporter training on 08/15/2022. 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.
-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.

REPORT CONTINUES ON NEXT PAGE 3 of 5

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022

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: SARGSYAN FAMILY CHILD CARE	FACILITY NUMBER: 198021096
	VISIT DATE: 10/03/2022

NARRATIVE

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-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: Applicant states that she will care for infants. Applicant states that infants will sleep in the living room and daycare two bedrooms 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 Applicant infants can not be swaddled while in care. LPA advised the Applicant 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.

SAFE SLEEP: LPA discussed the safe sleep regulations with applicant 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.
REPORT CONTINUES ON NEXT PAGE 4 of 5

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022

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: SARGSYAN FAMILY CHILD CARE	FACILITY NUMBER: 198021096
	VISIT DATE: 10/03/2022

NARRATIVE

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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 applicant, there are no dual licenses at this address. Applicant’s email address was obtained during this inspection. The applicant was advised that email may be public information.

Per applicant, she does not carry liability insurance or a bond in accordance with standard established by Family Child Care statue. Signed statements (LIC282) will be on children’s files. 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.

During this inspection applicant was observed to be in compliance with Title 22 Regulation.

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 applicant, Ofelia Sargsyan at 12:30 p.m..

REPORT END 5 of 5

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022

LIC809 (FAS) - (06/04)

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