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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503911522
Report Date: 03/24/2022
Date Signed: 03/25/2022 11:30:53 AM

Document Has Been Signed on 03/25/2022 11:30 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:SARGEZIAN, LENET FAMILY CHILD CAREFACILITY NUMBER:
503911522
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 3CENSUS: 3DATE:
03/24/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Licensee, Lenet SargezianTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Stefanie Galvan met with Licensee, and conducted an announced case management inspection. Licensee requested to place this facility on inactive status, effective 1/28/2022, which was granted. The purpose of todays visit is to reinstate the license as requested. Licensee, her husband and three minors reside in the home. A tour and inspection of the home, inside and outside, was completed. Background clearances were discussed and the LIS 531 was signed, indicating that the adults living in the home and/or providing care and supervision to children are background-cleared. LPA observed safe toys, safe indoor and outdoor play areas, child safety latches on cabinets and/or cabinets without unsafe items; the home was clean and orderly. Smoke alarm, fire extinguisher and carbon monoxide detector are operable and in place.

Rooms that are accessible to day care children will be the living room, dining room, main bathroom, second living room area (childcare room) and two bedrooms. The rest of the home including the laundry room and master bedroom is off-limits and made inaccessible by child safety gates, spinning plastic door knobs, and/or latches above child reach. There are no stairs in the home. The fireplace, located in the second living room (childcare room) is blocked by a gate and will not be used during childcare hours. Medication and cleaning supplies are inaccessible. There are firearms in the home, they are stored in a locked safe, separate from ammunition. There are no bodies of water in the home. EMSA-certified First Aid/CPR training is current and expires: 1/2023 and the licensee has proof of immunizations for herself. Licensee also completed the Mandated Reporter training.

Continued on 809-C
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Stefanie Galvan
LICENSING EVALUATOR SIGNATURE: DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2022
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: SARGEZIAN, LENET FAMILY CHILD CARE
FACILITY NUMBER: 503911522
VISIT DATE: 03/24/2022
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Required postings are correct. LPA discussed the practice of maintaining a child roster, as well as conducting fire drills at least once every 6 months and to document the date, time and number of children (no names). LPA also provided the licensee with information on Safe Sleep requirements and reviewed the regulation changes. Information on Lead Poisoning was also provided to the licensee and she was informed that copies need to be provided to all current parents and any future parents of children enrolled along with posting the information on the parent board.
LPA informed licensee about the Community Care Licensing website: www.ccld.ca.gov. and discussed with licensee about the new additions to the website that include the new PIN (Provider Information Notification) and information for providers including the Quarterly Updates that inform licensees of new legislation and regulations. Licensee was advised that forms and updated information may be obtained on the CCLD website and was also advised that it is her responsibility to stay current with regulations.

Business hours are Mon-Fri 6:00 AM to 6:00 PM and other hours as arranged.

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.

This home meets the description of a safe and healthy environment for children as described in Chapter 3, Division 12, Title 22 of California Code of Regulations and licensure for a capacity of up to 8 children is approved.


LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Stefanie Galvan
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022
LIC809 (FAS) - (06/04)
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