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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376627059
Report Date: 09/13/2021
Date Signed: 09/13/2021 01:35:47 PM

Document Has Been Signed on 09/13/2021 01:35 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:GABRELYAN, NARINA FAMILY CHILD CAREFACILITY NUMBER:
376627059
ADMINISTRATOR:NARINA GABRELYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 315-1370
CITY:SAN DIEGOSTATE: CAZIP CODE:
92128
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 10DATE:
09/13/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Narina GabrelyanTIME COMPLETED:
01:40 PM
NARRATIVE
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On 09/13/2021 at 11:25am, Licensing Program Analyst (LPA) Selina Siao conducted an unannounced random inspection with the Licensee. The home was toured and inspected to ensure an environment safe for the care and supervision of children. Present at the facility were the Licensee, helper Summer Lewis and 10 day care children including a child that is under two year old. The home has a fully charged fire extinguisher size 2A10BC, smoke and carbon monoxide detector that meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. Licensee stated that there are no bodies of water or weapons in the home. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances. Licensee’s First Aid and CPR certifications are not from an EMSA approved trainer therefore she will need to retake both classes. Licensee and her helper have completed the online mandated child abuse training during August of 2021 and it's valid for two years. Both licensee and helper have the required immunization records available for review. Ten children’s records were reviewed and all have an identification and emergency form in their file along with the other required licensing forms. Licensee has the safe sleeping log for the infant in care. Facility has an updated roster and fire drill log available for review. Licensee last conducted a drill with the children in care on 06/03/2021. An updated roster was obtained during today's inspection.

Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for child care include front living room (play, lunch and activity area), office for napping and bathroom.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2021
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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: GABRELYAN, NARINA FAMILY CHILD CARE
FACILITY NUMBER: 376627059
VISIT DATE: 09/13/2021
NARRATIVE
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Off limits areas include the back living room, kitchen, dining area and upstairs. The areas are inaccessible through use of multiple safety gates. The facility has sufficient toys and equipment available. The home has a fenced backyard with an enclosed gated area available for outdoor activities.

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

The following items were discussed with provider: Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care. Licensee was provided with information about Heat Related Illness, Sudden Infant Death Syndrome (SIDS), Never Shake a Baby, safe sleep for infants, best practice on supervision, latest car seat poster and effects of lead exposure and reporting responsibilities were discussed. The ABC’S of Safe Sleep: Sleep is Safest: Alone, on their Back in an empty Crib on a firm mattress.

Child Care Providers can sign up for Quarterly Updates and PINS through the DSS website www.ccld.ca.gov. LPA discussed California Megan's Law: www.meganslaw.ca.gov.

See LIC809D for deficiency:

A Notice of Site Visit was posted during the inspection and it must remain posted for a period or 30 days. Failure to keep notice posted will result in a civil penalty of $100.00. Provided appeal rights to licensee today.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 09/13/2021 01:35 PM - It Cannot Be Edited


Created By: Selina Siao On 09/13/2021 at 01:04 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: GABRELYAN, NARINA FAMILY CHILD CARE
FACILITY NUMBER: 376627059

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/18/2021
Section Cited
CCR
102416(c)

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Personnel Requirements
The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
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Licensee stated that she will retake both pediatric CPR and First Aid courses and will submit a copy of the cards to Analyst upon completion no later than 10/18/2021.
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This requirement is not met as evidence that licensee's CPR and First Aid cards are not from an EMSA approved trainer. This poses a potential health and safety risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Monica Cuddy
LICENSING EVALUATOR NAME:Selina Siao
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2021


LIC809 (FAS) - (06/04)
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