198021511-9-2-2025-33-CC-SSAN-DL5NCY-20250902102131

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198021511
Report Date: 09/02/2025
Date Signed: 09/02/2025 10:21:41 AM

Document Has Been Signed on 09/02/2025 10:21 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	SARGSYAN FAMILY CHILD CARE		FACILITY NUMBER:	198021511
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 3	DATE:	09/02/2025
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:39 AM
MET WITH:	Armine Sargsyan		TIME VISIT/ INSPECTION COMPLETED:	10:45 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	Case Management Inspection -Conducted in Armenian Licensing Program Analyst (LPA) Shushanik Safaryan conducted an unannounced case- management inspection to the above facility on 09/02/2025 due to licensee is requesting capacity increase. LPA arrived at the facility at 8:39 am and met with Armine Sargsyan , Licensee . Licensee guided analyst on a tour of the facility. During the tour LPA observed 3 children . During this inspection individuals who reside in the home were discussed and noted on Confidential Name List (LIC811) and attached to this report. Per licensee, facility hours are Monday to Saturday from 7:00 a.m. to 11:00 p.m. Licensee stated she will care for children from 0-13 years old. For Large Family Child Care Home Fire Clearance was granted on 07/31/2025. 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 bathroom , 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. LPA observed detached garage and storage separated with vinyl gate . Applicant stated door to the that area is locked and she does not have an access. Per applicant nobody resides in the detached garage and she will notify department if any changes occur . Per applicant, parents will enter the home through the main entrance which leads to the living room. Page 1 of 4

NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Shushanik Safaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: SARGSYAN FAMILY CHILD CARE	FACILITY NUMBER: 198021511
	VISIT DATE: 09/02/2025

NARRATIVE

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Areas that are accessible to children are as follows: Bathroom in the hallway, living room, dining room, kitchen, two bedrooms , back balcony, and front area of backyard fenced.

Areas off limits based on facility sketch submitted to children and parents include: 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.
All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness.

At 9:00 am, the licensee began touring LPA through the home starting with the entry way which led directly to the living room (daycare area).In the day care area, LPA observed small table , small chairs, toys . LPA observed parents board with all required postings. Next LPA toured bedroom #1 and observed bed . Next LPA toured bedroom #2 and observed child small beds and play pin. LPA toured the bathroom available for the children and observed cabinet where cleaning supplies stored had a child safety latch. Next LPA toured the dining area and observed couch and coffee table. LPA toured the kitchen and observed child safety latch on the cabinet under the sink where cleaning supplies stored. LPA observed child safety latch on the cabinet where sharp items stored. LPA observed child safety gate separating laundry area from kitchen area used by the children. LPA observed door leading to the back yard from laundry area. Licensee stated it is not used by the children. LPA discusses with the licensee that poisons need to be stored in the storage with the lock or combination lock inaccessible to the children. Next LPA toured the balcony and observed small table with chairs , toys and dining table with chairs. LPA observed child safety gate on the stairs of balcony separating outdoor play area from balcony .

Children use front part of the back yard for outdoor activities. Next LPA toured outdoor back yard area. LPA observed outdoor area had an artificial grass and toys for children. LPA observed AC unit was blocked off to prevent children access.
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NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Shushanik Safaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2025

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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: SARGSYAN FAMILY CHILD CARE	FACILITY NUMBER: 198021511
	VISIT DATE: 09/02/2025

NARRATIVE

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Next LPA observed detached garage and storage area separated with vinyl gate and door had a key lock . Next LPA observed door exiting to the street had a latch inaccessible to the children .

LPA observed the required 2A 10BC fire extinguisher was anchored in the kitchen with the purchase date 05/20/2025. Smoke and Carbon Monoxide were observed in the rooms.

Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to 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, Armine Sargsyan at 9:30 a.m. there are no pets, weapons, firearms, pools, spas, hot tubs, fishponds, or similar bodies of water on the premises.

The licensee was observed to be operating within the licensed capacity and is not exceeding the required limitations during this inspection. During this inspection 3 children were present in the facility with licensee.

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 completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expired on 04/2026.

Licensee completed required mandated reporter training on 05/13/2024. Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com. The licensee has proof of immunization against influenza, pertussis, and measles.

There are first aid supplies available in the kitchen . LPA advised licensee that if a child shows signs of illness, he/she/they shall be separated from other children.

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NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Shushanik Safaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2025

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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: SARGSYAN FAMILY CHILD CARE	FACILITY NUMBER: 198021511
	VISIT DATE: 09/02/2025

NARRATIVE

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Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted in the day care area.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family childcare facility.

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 stated she does not care for any infants at this time. Per licensee she has a play in in the bedroom available for the infant.

Medication: Incidental Medical Services (IMS) policy was discussed. 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.
Currently, the licensee is in compliance with California Title 22 Regulations.
Therefore, there are no citations being issued today from the areas that were inspected today.
The Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Licensee, Armine Sargsyan on 09/02/2025.

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NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Shushanik Safaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2025

LIC809 (FAS) - (06/04)

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