198021458-5-9-2024-33-CC-AEIN-D54MT3-20240509095253

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198021458
Report Date: 05/09/2024
Date Signed: 05/09/2024 09:52:58 AM

Document Has Been Signed on 05/09/2024 09:52 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:	POGHOSYAN FAMILY CHILD CARE		FACILITY NUMBER:	198021458
ADMINISTRATOR/ DIRECTOR:	ALINA POGHOSYAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 748-5778
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91201
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	05/09/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:35 AM
MET WITH:	Alina Poghosyan, Applicant		TIME VISIT/ INSPECTION COMPLETED:	10:00 AM

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	PRE-LICENSING INSPECTION CONDUCTED IN ARMENIAN Licensing Program Analyst (LPA) Anomeh Eivazian conducted an announced pre-licensing follow up inspection to the above facility on 05/09/2024. LPA arrived at the facility at 8:35 AM and met with Alina Poghosyan, Applicant who guided analyst on a tour of the facility. Per applicant operation hours will be Monday to Sunday, 7:00 a.m. to 11:00 p.m.. Applicant states she will care for children 0-12 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 1 bedroom, 1 restroom, living room, kitchen, front yard and backyard (fenced). Per applicant, parents will enter the home through the main entrance which leads to the living room. Areas that are accessible to children are as follows: One bathroom, living room, one bedroom, kitchen, and backyard fenced. Areas off limits based on facility sketch submitted to children and parents include: Front yard. Rooms that are off-limits need to be made inaccessible during operating hours The following corrections were observed during this inspection: 1. Applicant submitted a City of Glendale Permit to proof this address is permitted through the City of Glendale,and the home address is 1121 1/2 Raymond AVe, Glendale, CA 91201. 2. Applicant removed the wall heather in the living room and installed wall AC/heather in the living room out of reach of children. 3. Applicant submitted Landlord Consent Form LIC 9149. 4. Applicant submitted a copy of Rental Agreement. 5. Applicant submitted two bills under her name. 6. Applicant submitted a copy of CA ID interim proof. REPORT CONTINUES ON NEXT PAGE 1 of 3

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

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 3

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: POGHOSYAN FAMILY CHILD CARE	FACILITY NUMBER: 198021458
	VISIT DATE: 05/09/2024

NARRATIVE

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7. Applicant submitted an updated Emergency Disaster Plan LIC 610A.
8. Applicant submitted a written declaration that she lives at this address, she does not have another resident, she is the only adult who lives at this address and does not have outside employment.
9. Applicant made the backyard stairs which leads to the basement inaccessible to the children.
10. LPA observed a child safety latch on the storage above the sink in the bathroom.
11. Applicant submitted a written declaration that she will work separately from other family child care home providers, regardless of relation and she will not comingle her day care children with Manukyan Family Child Care 198020486, which is located in the front house at any time.
12. Applicant submitted an updated Application form LIC 279 and updated facility address from 1121 Raymond Ave unit A, to 1121 1/2 Raymond Ave.

LPA Eivazian reviewed and discussed with the applicant the following Title 22 Regulations to ensure applicant will maintain compliance and always meet the Title 22 regulations.

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.
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.

REPORT CONTINUES ON NEXT PAGE 2 of 3

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: POGHOSYAN FAMILY CHILD CARE	FACILITY NUMBER: 198021458
	VISIT DATE: 05/09/2024

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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 Eivazian explained to the applicant that applicant is required to operate separately from other providers regardless of family relationships. There is a front home in front, 1121 Raymond Ave., Glendale, CA 91201. The front home owner is also Family Child Care Home provider with facility number 1980201458. Per applicant she is not related to the front home licensee.

The Department addressed the applicant requirement for enrolled children to be at this facility all the time during daycare hours. Enrolled children’s parents are required to be fully aware and clear on who is the licensee and caregiver to the children in care. Co-mingling of children between the two separate licenses is a violation of Title 22 regulations.

Per applicant, her facility Rosters and children's files for enrollment will be updated.

- Applicant will always interact with Department staff professionally and respectfully.
- Applicant understands that inspections are conducted in person, unannounced, and Department staff will be granted access to the facility as part of the inspection process.
- Applicant will be forthright with the department at all the times to ensure the health and safety of children in care.
- Applicant will be the main person to provide care to the children and interact with families.

Exit interview conducted and report was reviewed with applicant Alina Poghosyan.

REPORT END 3 OF 3

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

LIC809 (FAS) - (06/04)

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