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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021191
Report Date: 04/17/2023
Date Signed: 04/17/2023 12:04:33 PM

Document Has Been Signed on 04/17/2023 12:04 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:MARGARIAN FAMILY CHILD CAREFACILITY NUMBER:
198021191
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/17/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Asmik Margarian, ApplicantTIME COMPLETED:
12:10 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 04/17/2023. LPA arrived at the facility at 8:30 AM and met with Asmik Margarian and Alvard Margaryan, Applicants who guided analyst on a tour of the facility. Pre-licensing Entrance Checklist (LIC9280) was provided to applicant, Asmik Margarian. During this inspection Armine Margaryan, applicant sister was present 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. A COVID 19 risk assessment was conducted prior to entering the facility. Per applicant operation hours will be Monday to Friday, 7:00 a.m. to 6:00 p.m.. Applicant states she will care for children 1-10 years old.

All areas identified on the facility sketch were inspected. This is a one story home located on the first level. The home consists of 2 bedrooms, 2 restrooms, living room (main daycare area), kitchen, laundry room, front yard and backyard (fenced). Per applicants, parents will enter the home through the main entrance which leads to the living room.

Areas that are accessible to children are as follows: Bathroom in the living room, living room (main day care area), kitchen, one bedroom and backyard (fenced).

Areas off limits based on facility sketch submitted to children and parents include: One bedroom, bathroom in the hallway, laundry room, and front yard.
**Rooms that are off-limits need to be made inaccessible during operating hours**
The applicants do understand that licensing staff may have access to off-limit areas during inspection if necessary.
REPORT CONTINUES ON NEXT PAGE 1 of 6
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/17/2023
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: MARGARIAN FAMILY CHILD CARE
FACILITY NUMBER: 198021191
VISIT DATE: 04/17/2023
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At 9:00 am, the applicants began touring LPA’s through the home starting with the entry way which lead directly to the living room (main daycare area).The living room was inspected and electrical outlets were observed to be covered. LPA observed children tables, chairs, toys, a TV, and a sofa in the living room. Next LPA toured the bathroom in the living room and did not observe any hazards. Next LPA toured the one bedroom and observed napping cots and a bed in the bedroom. Next LPA toured the off-limit bathroom in the hallway and did not observe any hazards. LPA observed a plastic door knob on the off-limit bathroom door. Next LPA toured the off-limit bedroom and did not observe any hazards. LPA observed a plastic door knob on off-limit bedroom door knob. Next LPA toured the kitchen and observed child proof safety latches on the cabinets where applicant stores sharp items and cleaning compounds. Per applicant, no poisons are kept in the home. LPA observed the required 2A 10BC fire extinguisher was anchored to the wall in the backyard. Per applicants, it was purchased on 02/2023 but was not able to locate the receipt. 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 applicants, 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. LPA observed the outdoor playarea ground is artificial grass. There is a gate in the backyard which leads to the Columbus Ave. Per applicants, this gate will be kept closed all the times during daycare hours. The applicants state that supervision is always provided.

The applicants state that she 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 10:00 am, there are no pets, weapons, firearms or bodies of water on the premises. There are toys available for children. There is not a telephone service available in the home during this inspection. 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 kit in the home, in the living room.
REPORT CONTINUES ON NEXT PAGE 2 of 6
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023
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: MARGARIAN FAMILY CHILD CARE
FACILITY NUMBER: 198021191
VISIT DATE: 04/17/2023
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Applicants have proof of CPR and First Aid training as indicated on the certificate. The applicants do have proof of Health and Safety training (completion date: Asmik Margarian: 01/14/23 and Alvard Margaryan: 03/18/23), Pediatric First Aid and CPR (ex. Asmik Margarian:01/25 and Alvard Margaryan: 03/25). The applicants have proof of immunization against influenza, pertussis, and measles.
Applicants are exempt from required mandated reporter training due to language barrier. Per applicants, they only speaks Armenian. Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com

The following was discussed with the applicants:
Applicants were 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.
REPORT CONTINUES ON NEXT PAGE 3 of 6
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023
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: MARGARIAN FAMILY CHILD CARE
FACILITY NUMBER: 198021191
VISIT DATE: 04/17/2023
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-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.
- Applicants 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 she will care for infants. Applicants state that infants will sleep in the living room and daycare bedroom 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 Applicants. 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 applicants 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 5 of 6
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: MARGARIAN FAMILY CHILD CARE
FACILITY NUMBER: 198021191
VISIT DATE: 04/17/2023
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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 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, they do 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 Eivazian reviewed and discussed with the applicant the following Title 22 Regulations to ensure applicants will maintain compliance and meet the Title 22 regulations at all times.


Provider must reside in the home where care is being provided:
Definitions--102352 -- "Family Day Care" or "Family Child Care" means regularly provided care, protection and supervision of children, in the care giver's own home, for periods of less than 24 hours per day, while the parents or authorized representatives are away. The term "Family Child Care" supersedes the term "Family Day Care" as used in previous regulations and "Home" means the licensee's residence as defined by Government Code Section 244.
REPORT CONTINUES ON NEXT PAGE 4 of 6
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023
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: MARGARIAN FAMILY CHILD CARE
FACILITY NUMBER: 198021191
VISIT DATE: 04/17/2023
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Provider must be present 80% of the time providing care as stated in the following regulation:
Operation of a Family Child Care Home--102417 (a)-- The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.
Reporting Requirements--102416.2 (a) (2)--Any change in household composition including adults moving in or out of the home and anyone living in the home who reaches his or her 18th birthday.
Inspection Authority of the Department—102391 (a)--Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation of, the regulations adopted by the Department governing family child care homes, and in accordance with Section 102396.
LPA reviewed with applicants 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.
The following corrections need to be corrected prior to obtaining a small family child care license. Corrections are due by 05/05/23.
1. Applicants will have a working telephone line available in the home.
2. Applicants will submit copies of CA ID for herself and Alvard margarian.
3. Applicants will add a plastic door knob and a chain latch to the main entrance for additional safety.
4. Applicants will add railing to the backyard two stairs for additional safety.
5. Applicants will submit a declaration explaining this is her only resident, does not have outside employment, she lives 100% at this address, and she will be present in the home 80% of daycare hours.
6. An updated Family Child Care Home application will be submitted to add Alvard Margaryan as co-licensee.
7. Applicant, Alvard Margaryan will submit Family Child Home Orientation Certificate.
8. Applicants will submit an updated Rental Agreement.
A small 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 Applications 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, Asmik Margarian and Alvard Margaryan at 12:10 PM.
REPORT END 6 of 6
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023
LIC809 (FAS) - (06/04)
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