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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021622
Report Date: 12/02/2024
Date Signed: 12/02/2024 12:08:20 PM

Document Has Been Signed on 12/02/2024 12:08 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:
198021622
ADMINISTRATOR/
DIRECTOR:		SARGSYAN, NAIRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 229-5907
CITY:LOS ANGELESSTATE: CAZIP CODE:
90038
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
12/02/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Naira Sargsyan, ApplicantTIME VISIT/
INSPECTION 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 12/02/24. LPA arrived at the facility at 8:40 AM and met with Naira Sargsyan, Applicant who guided analyst on a tour of the facility. Pre-licensing Entrance Checklist (LIC9280) was provided to applicant, Naira Sargsyan. During this inspection individuals who reside in the home were discussed and notes on Confidential Name List (LIC811) and attached to this report. Per applicant operation hours will be Monday to Friday, 8:00a.m. to 5:00 p.m.. Applicant states she will care for children 3 months old-13 years old.

Applicant previously was licensed at 1329 N. Alexandra Avenue, Los Angeles, CA 90027 with facility number 198018112.

All areas identified on the facility sketch were inspected. This is a one story home located on the first level. The home consists of 3 bedrooms, 2 restrooms, living room, dining room, kitchen, and front yard. Per applicant, during pick up and drop off time she will leave the front main gate half way open to let the parents enter the home and drop off and pick up the children from the main entrance door which leads to the living room.

There are two other homes on this property with separated addresses. The front home is 5426 Lemon Grove, Los Angeles, CA 90038 and 5424 Lemon Grove, Los Angeles, Ca 90038. Applicant's family members reside at these two address. Applicant's daughter, Mariam Baghdasaryan who resides at 5424 Lemon Grove Ave., Los Angeles, CA 90038 applied for family child care home license with facility number 198021623.

Areas that are accessible to children are as follows: Bathroom in the hallway, living room, dining room, kitchen, two bedrooms, and front yard.
Areas off limits based on facility sketch submitted to children and parents include: Master bedroom, and bathroom in the master bedroom. **Rooms that are off-limits need to be made inaccessible during operating hours**
REPORT CONTINUES ON NEXT PAGE 1 of 8
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2024
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: SARGSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021622
VISIT DATE: 12/02/2024
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Per applicant, she will use the front yard on a staggered schedule in the mornings with her daughter, Mariam Baghdasarya daycare, 198021623. Applicant will use the front yard from 10:00 AM to 10:30 AM and Baghdasaryan Family Child Care will use the front yard from 10:45AM to 11:15 AM. Per applicant, she will use the front yard in the afternoon and Baghdasaryan Family Child Care will use the side yard in the afternoon which is separated by three feet high gate. Per applicant, she will never commingle her daycare children with Baghdasaryan Family Child Care.

The applicant does understand that licensing staff may have access to off-limit areas during inspection if necessary.

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 and dining room. The living room and dining room were inspected and electrical outlets were observed to be covered. LPA observed children toys, tables and chairs in the living room and dining room. Next to the living room, The kitchen was inspected, and LPA observed latches on the cabinets which stores cleaning compounds and sharp items. Next LPA toured the bedroom adjacent to the living room and observed a desk in the bedroom. Next LPA toured the off-limit master bedroom and bathroom in the master bedroom and observed applicant's personal belongings in the bedroom. Next LPA toured the bathroom in the hallway and did not observe any hazards. Next LPA toured the next bedroom and observed children toys in the bedroom. There is a door in the bedroom which leads to off-limit back area. LPA observed an operable door alarm on the door. LPA did not observe accessible hazards. LPA observed the required 2A 10BC fire extinguisher was anchored to the wall in the kitchen. It was purchased on 05/31/24 as read by LPA from the receipt. Applicant tested the carbon monoxide and smoke detectors in the hallway of bedrooms. 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 front yard fenced. Per applicant, children will use the front yard for outdoor play time. The outdoor play area was observed to be fenced. LPA observed a three feet high gate in the front yard prior to the main gate which is six feet high. 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 applicant states that supervision is always provided.


REPORT CONTINUES ON NEXT PAGE 2 of 8
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024
LIC809 (FAS) - (06/04)
Page: 2 of 8
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: 198021622
VISIT DATE: 12/02/2024
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APPLICANT RENTS/LEASES THE HOME: The applicant, Naira Sargsyan provided proof of control of property. Applicant confirmed that LIC 9149 was signed by landlord.

APPLICANT RENTS/LEASES THE HOME AND HAS LANDLORD CONSENT: Because the applicant, Naria Sargsyan 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).

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 10:30 am, there are no pets, weapons, firearms or bodies of water on the premises. There are toys available for children. There is not telephone service available in the home during this inpsection. 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 not provide transportation.

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: 11/09/24), Applicant did not have current Pediatric First Aid and CPR during this inspection. The applicant has proof of immunization against influenza, pertussis, and measles. Applicant completed required mandated reporter training on 09/24/24. 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.

REPORT CONTINUES ON NEXT PAGE 3 of 8
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024
LIC809 (FAS) - (06/04)
Page: 3 of 8
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: 198021622
VISIT DATE: 12/02/2024
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-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.
-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 daycare bedrooms 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 8
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024
LIC809 (FAS) - (06/04)
Page: 4 of 8
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: 198021622
VISIT DATE: 12/02/2024
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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.



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:

REPORT CONTINUES ON NEXT PAGE 5 of 8
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024
LIC809 (FAS) - (06/04)
Page: 5 of 8
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: 198021622
VISIT DATE: 12/02/2024
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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 Eivazian explained to the applicant that Applicant is required to operate separately from other providers regardless of family relationships. Applicant's daughter, Mariam Baghdasaryan applied for a family childcare home license with facility number 198021623, for the ADU/ adjacent to this address house located at 5424 Lemon Grove, Los Angeles, CA 90038.

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. Children are not allowed to go back and forth between applicant'’s address and Baghdasaryan FCC, 198021623 located at 5424 Lemon Grove, Los Angeles, CA 90038. Applicant and her daughter, Mariam Baghddasaryan will use the front yard on a staggered schedule in the mornings and in the afternoon applicant will use he front yard and Baghdasaryan Family Child Care will use her facility side yard which is separated by 3 feet high gates. Per applicant, children will not commingle between two facilities at anytime. Co-mingling of children between the two separate licenses is a violation of Title 22 regulations.
REPORT CONTINUES ON NEXT PAGE 6 of 8
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024
LIC809 (FAS) - (06/04)
Page: 6 of 8
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: 198021622
VISIT DATE: 12/02/2024
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Per applicant 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.

Applicant submitted a written declaration signed and dated 12/02/24 that she will not comingle her day care children with Baghdasaryan FCC 198021623 daycare children at any time and applicant resides at this address.

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.

Megan’s Law - Family Child Care Homes On this date, 11/20/24 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


REPORT CONTINUES ON NEXT PAGE 7 of 8
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024
LIC809 (FAS) - (06/04)
Page: 7 of 8
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: 198021622
VISIT DATE: 12/02/2024
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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 01/03/25:



1. Applicant will have a crib for infants 0-12 months old.
2. Applicant will have a working telephone services in the home.
3. Applicant will submit a copy of Family Child Care Home Orientation Certificate.
4. Applicant will submit two bills under her name for this address.
5. Applicant will submit proof from City of Los Angeles to proof this is a permitted property through City of LA.
6. Applicant will submit current pediatric first aid and cpr certificate.

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, Naira Sargsyan.

REPORT END 8 of 8

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

DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024
LIC809 (FAS) - (06/04)
Page: 8 of 8