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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021511
Report Date: 06/24/2024
Date Signed: 06/24/2024 12:05:14 PM

Document Has Been Signed on 06/24/2024 12:05 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 CAREFACILITY NUMBER:
198021511
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/24/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Armine Sargsyan, ApplicantTIME VISIT/
INSPECTION COMPLETED:
12:15 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 06/24/24. LPA arrived at the facility at 8:40 AM and met with Armine Sargsyan, Applicant who guided analyst on a tour of the facility. Pre-licensing Entrance Checklist (LIC9280) was provided to applicant, Armine Sargsyan. During this inspection applicant's husband, Khachik Sargsyan was also 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 Saturday, 7:00 a.m. to 10:00 p.m.. Applicant states she will care for children 0-13 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, 1 restroom, living room, dining room, kitchen, front yard, back balcony, backyard (fenced). There is a detached back house in the backyard which consists of two bedrooms, kitchen, one bathroom, and living room. There is a detached storage in the backyard. 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: Bathroom in the hallway, living room, dining room, kitchen, one bedroom, back balcony, and front area of backyard fenced.

Areas off limits based on facility sketch submitted to children and parents include: One bedroom and front yard in the main home. Detached back house in the backyard which consists of two bedrooms, kitchen, one bathroom, and living room and detached storage in the backyard.
**Rooms that are off-limits need to be made inaccessible during operating hours**
The applicant does 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: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2024
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 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: SARGSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021511
VISIT DATE: 06/24/2024
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At 9:00 am, the applicant began touring LPA’s through the home starting with the entry way which lead directly to the living room. 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. LPA observed children tables, chairs and toys in the living room. Next LPA toured the dining room and observed a sofa and coffee tables in the dining room. Next LPA toured the kitchen and observed children safety latches on the cabinets where applicant stores sharp items and cleaning compounds. LPA observed a child safety gate was installed in the kitchen which leads to the laundry area. There is a door in the kitchen which leads to the backyard. Next LPA toured the one off-limit bedroom and observed a bed and applicant's family members personal belongings in the bedroom. Next LPA toured the one daycare bedroom and observed three beds in the bedroom. Next LPA toured the one bathroom in the hallway and did not observe any hazards. LPA observed the required 2A 10BC fire extinguisher was anchored to the wall in the laundry area. It was purchased on 05/14/24 as read by LPA from the receipt. Applicant tested the carbon monoxide and smoke detectors in the kitchen. 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. Per applicant, children will use the front area of back yard and back balcony 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 observed there are four stairs in the balcony which leads to the backyard and has not been barricaded. There is a gate in the backyard which leads to the street. Per applicant, backyard gate will be kept closed all the time. Next LPA toured the off-limit detached back house which consists of two bedrooms, one bathroom, kitchen and living room and did not observe any hazards. Per applicant, the blockhouse is not occupied at this time and landlord is in process to turn the back house to ADU. There is a connecting gate in the backyard which leads to the detached back house. Per applicant, they will not use the connecting gate and it will be kept locked all the time. Off-limit areas in the backyard has been separated with six feet vinyl gates to make the off-limit areas inaccessible to the children. LPA did not observe any objects that can pose a danger to children on the outdoor yard. The applicant states that supervision is always provided.

APPLICANT RENTS/LEASES THE HOME: The applicant provided proof of control of property.

REPORT CONTINUES ON NEXT PAGE 2 of 6
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2024
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: 198021511
VISIT DATE: 06/24/2024
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APPLICANT RENTS/LEASES THE HOME AND HAS LANDLORD CONSENT: Because the applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149). Applicant confirmed that LIC 9149 was signed by landlord.

The applicant states that she 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 11:00 am, there are no pets, weapons, firearms or bodies of water on the premises. 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. Per applicant, she will provide transportation if it will be needed.

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: 10/10/2020), Pediatric First Aid and CPR (ex. 04/2026). The applicant has proof of immunization against influenza, pertussis, and measles.
Applicant completed required mandated reporter training on 05/13/2024. 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.

REPORT CONTINUES ON NEXT PAGE 3 of 6
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2024
LIC809 (FAS) - (06/04)
Page: 3 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: SARGSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021511
VISIT DATE: 06/24/2024
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-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.
-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 one daycare bedroom where they are constantly supervised. 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.
REPORT CONTINUES ON NEXT PAGE 4 of 6
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2024
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: SARGSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021511
VISIT DATE: 06/24/2024
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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.

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.

REPORT CONTINUES ON NEXT PAGE 5 of 6
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2024
LIC809 (FAS) - (06/04)
Page: 5 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: SARGSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021511
VISIT DATE: 06/24/2024
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Megan’s Law - Family Child Care Homes On this date, 06/13/24, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

MyChildCarePlan.org--Child Care Centers and Family Child Care Home applicant was informed of the MyChildCarePlan.org site, 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

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.


The following corrections need to be corrected prior to obtaining a small family child care license. Corrections are due by 07/24/24:
1. Applicant will add a gate to the balcony stairs which leads to the backyard for additional safety.
2. Applicant will have a pack n'play or crib for infants under 1 year old.
3. Applicant will submit a written declaration that she lives at this address and does not have other resident.
4. Applicant will submit a written declaration that backyard gate which leads to the back house will be kept locked all the times and will not be used for commute.
5. Applicant will cover back balcony fencing opening for additional safety.

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 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, Armine Sargsyan.

REPORT END 6 of 6

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2024
LIC809 (FAS) - (06/04)
Page: 6 of 6