343625443-2-28-2024-03-CC-EPGO-D2VUEX-20240228143153

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343625443
Report Date: 02/28/2024
Date Signed: 02/28/2024 02:31:59 PM

Document Has Been Signed on 02/28/2024 02:31 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	SARGSYAN, SUSANNA		FACILITY NUMBER:	343625443
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 1	DATE:	02/28/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	12:25 PM
MET WITH:	Susanna Sargsyan		TIME COMPLETED:	02:45 PM

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	Licensing Program Analyst (LPA) Erwina Pascual-Golamco met with Applicant Susanna Sargsyan, for the purpose of a pre-licensing inspection. There was one cleared adult and 1 child in the home during the inspection. Adult relative was present for translation. All individuals subject to criminal background review have obtained a criminal record clearance. Applicant plans to operate Monday to Friday 8:00 AM to 8:00 PM. 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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated. The applicant provided proof of control of property. A health and safety inspection were conducted inside and out. This facility is a two story home. The first floor has a dining room, living room, kitchen, one bedroom, one bathroom, and garage. The second floor has 3 bedrooms and 1.5 bathrooms. The off-limit areas will be: the entire second floor, garage and left side of yard. Off-limits areas will remain inaccessible to children by closed doors and/or supervision. LPA observed a safety gate which is barricading the upstairs area. Applicant understands that whenever children under the age of five are present the safety gate must be up, preventing access to the second floor. LPA observed a fireplace in the living room area which is barricaded. Toxic and hazardous items are inaccessible to children and are stored in the latched kitchen cabinets. Functioning smoke and carbon monoxide detectors and 2A-10-BC fire extinguisher were observed in the home. LPA received EMSA certificate for Preventative Health, Safety, Nutrition, and Lead Poisoning Class training, Applicant's EMSA Pediatric CPR and First Aid training is valid until 10/2025. Applicant understands Pediatric CPR and First Aid training must be renewed every two years. Applicant stated that there are no weapons or firearms in the home. Backyard is fenced, supervision was discussed, and applicant understands that children must be 100% supervised in unfenced yards. Immediate Civil Penalty regulation and deficiencies were reviewed. LPA observed a spa/hot tub located in the backyard, the spa cover is locked and secured in place so a child cannot slip under or undo, has a locking mechanism that has a key or tool to unlock or remove, and the ladder is inaccessible to children. Applicant stated spa is not being used, and just waiting to be removed from the home. Continued on LIC809-C...

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SARGSYAN, SUSANNA	FACILITY NUMBER: 343625443
	VISIT DATE: 02/28/2024

NARRATIVE

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Incidental Medical Services (IMS) was discussed with Applicant. 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 consulted applicant regarding the following topics; new upcoming regulations, Type A vs. Type B deficiencies, complaints, LPA’s right to interview children without parental consent, civil penalties, incidental medical services, placement of detergents, poisons and medicines, announced vs. unannounced inspections, posting requirements, unusual incident reports, On-limits vs. Off-limit areas, licensing file management, fire drills, 80% supervision, 100% supervision, fingerprint clearances, advertising, mandated reporting and best practices.

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.

LPA consulted the applicant regarding personal rights. Applicant understands that corporal, physical and/or unusual forms of punishment is never allowed toward day care children or their own children during day care hours.
LPA reviewed with applicant the LIC311D, Forms/Records to Keep in Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Applicant was encouraged to visit the department website at WWW.CDSS.CA.GOV for information regarding childcare updates, forms, self-assessment guides, regulations and legislation pertaining to family childcare homes. LPA advised licensee of their responsibility to stay current regarding new regulations.

Continued on LIC809-C...

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SARGSYAN, SUSANNA	FACILITY NUMBER: 343625443
	VISIT DATE: 02/28/2024

NARRATIVE

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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. LPA advised Applicant to sign up for the quarterly updates provided by the Childcare Advocates Program. To receive important license 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. Applicant is subscribed as of today.

On this date, 11/22/23, 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.

Effective today 02/28/2024, licensed for Small Family Childcare Home.

Facility is approved for a small family childcare home license to serve a capacity of 6 children with no more than 3 infants or 4 infants only. Or with a capacity of 8 children: no more than 2 infants, 1 child in kindergarten or elementary school and 1 child at least age 6. Exit interview conducted.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

LIC809 (FAS) - (06/04)

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