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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021148
Report Date: 11/19/2024
Date Signed: 11/19/2024 11:14:50 AM

Document Has Been Signed on 11/19/2024 11:14 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:KARAPETYAN FAMILY CHILD CAREFACILITY NUMBER:
198021148
ADMINISTRATOR/
DIRECTOR:		ANI KARAPETYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 484-1282
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/19/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Ani Karapetyan, LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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ANNUAL INSPECTION CONDUCTED IN ARMENIAN
Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced Annual/Random inspection to the above facility on 11/19/24 LPA arrived at the facility at 8:30 AM and met with licensee, Ani Karapetyan who guided analyst on a tour of the facility. Also present during this inspection, was Eduard Karapetyan, Licensee’s brother. LPA provided a copy of Entrance Checklist—Family Child Care Home (LIC126) to licensee. Per licensee, facility operation hours are Monday to Friday, 7:00 a.m. to 6:00 p.m.. Licensee states she care for children 6 months old to 12 years old. Per licensee, currently she does not have any children enrolled in her daycare.

This is a one story home located on the first level. The home consists of 2 bedrooms, 1 restroom, living room, dining room, kitchen, front yard, back yard (fenced), patio in the backyard, detached converted garage (guest house) in the backyard which consists of two rooms, kitchen and one bathroom, storage in the backyard. Per licensee, parents enter the home through the main entrance door which leads to the living room or side gate gate which leads to the backyard.

Per licensee the children use the bathroom in the hallway, living room, dining room, kitchen, one bedroom adjacent to the living room, kitchen, patio in the backyard, and backyard (fenced). Per licensee areas off limits to children and parents include: One bedroom, storage in the backyard, detached guest house in the backyard, and front yard. During this inspection individuals who reside in the home were discussed and notes on Confidential Name List (LIC811) and attached to this report.

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. The living room was inspected and electrical outlets were
REPORT CONTINUES ON NEXT PAGE 1 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2024
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: KARAPETYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021148
VISIT DATE: 11/19/2024
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observed to be covered. LPA observed fireplace was screened in the living room to make it inaccessible to the children. LPA observed sofas and a coffee table in the living room. Next LPA toured the dining room and observed a dining table and chairs in the dining room. There is a glass sliding door in the dining room which leads to the baloney. LPA observed a lock on the dining room door. Next LPA toured the kitchen and observed child proof safety latches on the cabinets where applicant stores sharp items and cleaning compounds. There is a door in the kitchen which leads to the backyard. Next LPA toured the daycare bedroom and observed children toys in the bedroom. Next LPA toured the bathroom in the hallway and did not observe any hazards. Next LPA toured the off-limit bedroom and observed a bed and licensee's personal belongings in the home. Per licensee no poisons are kept in the home. LPA observed the required 2A 10BC fire extinguisher was anchored to the wall by the half bathroom. It was serviced on 10/03/2022 as read by LPA from the service tag and it was not serviced annually as it is required. Licensee tested the carbon monoxide detector in the hallway of bedrooms and smoke detector in the living room. 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 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 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 licensee states that supervision is always provided. Next LPA toured the off-limit detached guests house and observed licensee's brother personal belongings in the bedroom. Per licensee, when she had children in care, there were occasions that children had access and played in the off-limit detached guests house. LPA informed licensee, that children can not enter the detached guests house as far as it is an off-limit area to the children.

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, Ani Karapetyan at 9:30 a.m there are no weapons, firearms, pools, spas, hot tubs, fish ponds, or similar bodies of water on the premises. Per licensee, currently there is a dog on the premises which is inaccessible to the children
REPORT CONTINUES ON NEXT PAGE 2 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
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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: KARAPETYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021148
VISIT DATE: 11/19/2024
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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 does not have any children 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 08/26. Licensee, Ani Karapetyan completed required mandated reporter training on 01/19/23. There are first aid supplies available on the premises in the closet in the hallway of bedrooms. LPA advised licensee that if a child shows signs of illness he/she/they shall be separated from other children.



The licensee has proof of immunization against influenza, pertussis, and measles. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill.
Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted at the wall by the entrance. Per licensee, she provides transportation.

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.

INFANT CARE: Licensee states that if an infant is enrolled, the infant will sleep in the daycare bedroom and living room 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: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
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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: KARAPETYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021148
VISIT DATE: 11/19/2024
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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/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 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. 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.

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.
To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.
A notice of site visit was given and must remain posted for 30 days.
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
Licensee, Ani Karapetyan was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
During the exit interview, the Licensee, Ani Karapetyan confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
Exit interview conducted and report was reviewed with the licensee, Ani Karapetyan.
REPORT END 4 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
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Document Has Been Signed on 11/19/2024 11:14 AM - It Cannot Be Edited


Created By: Anomeh Eivazian On 11/19/2024 at 09:52 AM
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: KARAPETYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021148

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/19/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation the licensee did not comply with the section cited above and fire extinguisher was serviced on 10/03/22 as read by LPA from service tag and it was not serviced annually as it is required which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/29/2024
Plan of Correction
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Per licensee, she will service the fire extinguisher and a picture of service tag will be submitted to LPA Eivazian via email by 11/29/24.
Type B
Section Cited
CCR
102416.3(a)(6)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on licensee verbal statement, the licensee did not comply with the section cited above and per licensee there were times that children had access to off-limit detached guests house which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/29/2024
Plan of Correction
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Per licensee, currently she does not have any children enrolled in her day-care, and currently licensee's brother is using the detached gusts house. Per licensee, she will not use the detached guests house as day-care area anymore. A written declaration will be submitted to LPA by 11/29/24.
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: 11/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/19/2024


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