Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015554
Report Date: 05/14/2019
Date Signed: 05/14/2019 01:24:54 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:GHAZARYAN & AVETISYAN FAMILY CHILD CAREFACILITY NUMBER:
198015554
ADMINISTRATOR:RFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 333-6185
CITY:TUJUNGASTATE: CAZIP CODE:
91042
CAPACITY:14CENSUS: 9DATE:
05/14/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Nella GhazaryanTIME COMPLETED:
01:39 PM
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Licensing Program Analyst (LPA) Lawson met with Licensee, Nella Ghazaryan, who guided analyst on a tour of the facility for an Random/Annual Inspection. This is a single story 3 bedroom, 3 bathroom home with kitchen/dining, formal dining room, living room, laundry room, and Accessory Dwelling Unit (re-purposed garage) which has been permitted by the City of Los Angeles. There is no pool/spa or body of water on the premises. Family members residing in the home include two adults (Licensee and Spouse) and two children. Days/hours of operation will be Monday through Friday from 7:30 AM to 5:30 PM. Incidental Medical Services (IMS) policy was discussed.

Main care is provided in the Accessory Dwelling Unit and children eat in the living room area. Children use the Bathroom located in the Accessory Dwelling Unit. Off limit areas include the all Bedrooms, Bathroom #2 and #3, Formal Dining Room, and kitchen. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating (central) and ventilation, inaccessibility to poisons, detergents/cleaning compounds, medicines and hazardous items that can pose a danger to children.

Backyard is completely fenced. No Pets.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Tyicee LawsonTELEPHONE: (661) 568-8103
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2019
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: GHAZARYAN & AVETISYAN FAMILY CHILD CARE
FACILITY NUMBER: 198015554
VISIT DATE: 05/14/2019
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Per Licensee, there are no weapons or firearms on the premise. LPA did not observe any in the home. There are age appropriate toys. Age appropriate napping equipment (cots). The required fire extinguisher (2A10BC) and smoke detector are in operable condition. The home has a Carbon Monoxide detector. Fireplace is screened (Living Room). Home has central AC and heat. CPR/First Aid expire 11/26/2020. The First Aid kit was observed and is complete.

Requirements for fingerprint clearances and associations were discussed with the Licensee.

Licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B. The "Notification of Parent's Rights" poster must be posted in an area of the home accessible to parents. The information regarding new legislation with regards to exemptions and Parent’s Rights was also discussed.

Licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. Copies of the reports must also be provided to each parent when a serious deficiency, Type A, is cited (LIC9224).
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Tyicee LawsonTELEPHONE: (661) 568-8103
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2019
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: GHAZARYAN & AVETISYAN FAMILY CHILD CARE
FACILITY NUMBER: 198015554
VISIT DATE: 05/14/2019
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Licensee informed to review Quarterly updates/regulations for 2015-2019 on the department website: Summer 2015 - Incidental Medical Services information.

Please be mindful of the following safe sleep best practices:

• Always place infants on their backs for sleeping

• Use only a tight-fitting sheet on the crib or play yard mattress

• Do not hang any items from the crib or above the crib

• Keep all items, including blankets, out of the crib or play yard

• Pacifiers may be used as long as they do not have items attached to them

• Infants should not be swaddled or have any items covering them while sleeping

• The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold

Note: the above guidelines are recommendations for best practices only, until regulations are approved and adopted.

Thank you for all that you do to help keep our children safe.

AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx

NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative

Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Tyicee LawsonTELEPHONE: (661) 568-8103
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: GHAZARYAN & AVETISYAN FAMILY CHILD CARE
FACILITY NUMBER: 198015554
VISIT DATE: 05/14/2019
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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.html

--Licensee was advised visit www.shotsforschool.org for Immunization information.


--Licensee was informed of responsibility to report suspected Child Abuse, 1-800-827-8724
--Family Child Care Providers (Disaster Planning information): https://ccld.family-child-care-providers/disaster-planning-and-fire-safety/
--Child Care Videos: https://ccld.childcarevideos.org
--Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov
--Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.

The On Duty Worker is available for questions at (661) 789-6944 Monday through Friday 8am-5pm.

No deficiencies cited. LPA provided consultation during inspection.



An exit interview was conducted and a copy of this report was read and provided to Licensee Nella Ghazaryan.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Tyicee LawsonTELEPHONE: (661) 568-8103
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2019
LIC809 (FAS) - (06/04)
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