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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700561
Report Date: 09/15/2022
Date Signed: 09/15/2022 02:56:42 PM

Document Has Been Signed on 09/15/2022 02:56 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:BOYAJYAN FAMILY CHILD CAREFACILITY NUMBER:
197700561
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
09/15/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Mariam BoyajyanTIME COMPLETED:
03:11 PM
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On 09/15/2022, Licensing Program Analyst (LPA) Justin Dorsey conducted an Capacity Increase Pre-Licensing inspection with Licensee, Mariam Boyajyan to ensure the facility meets basic licensing requirements set forth by Title 22, Health and Safety requirements. The Licensee is requesting to provide care for a Large family childcare home for the capacity of 14 children. According to the application there are 4 adults (Licensee and three other adults) in the home. LPA toured the home indoor and out to ensure it meets FCCH requirements. The Licensee is requesting the days and hours of operation will be Monday through Sunday 7:30am - 10:30pm.

The home is described as follows:

This is a one story home with 3 bedrooms, 2 bathrooms, kitchen, dining area, living room, and detached garage. The home has central heating and air conditioning.



Indoor:
Main area: Main care is provided in the living room area. Children use the bathroom in the hallway near the on limit bedrooms. Children have access to the backyard.
Bathroom #1: Children will use the bathroom #1 near the on limit bedrooms. The bathroom #1 was toured, and inspected, toilets are in operable condition. Toilet and faucets are clean, safe, and operable; bathtub and shower area free of hazard.
Kitchen: Sharp utensils, cleaning supplies, medicines; drawers and cabinets with plastic bags, and sharp things or small things children can swallow; are inaccessible to children. The home has a door which restricts children from entering the kitchen. The refrigerator dishwasher, stove, microwave, etc., are clean. The kitchen was clean, orderly, and free of hazardous items. Medications are stored in a off limit bedroom.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2022
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: BOYAJYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700561
VISIT DATE: 09/15/2022
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Outside: The backyard was inspected. The backyard is completely fenced children will play outside in the backyard. There is grass, turf, dirt and concrete for children to play. LPA observed toys and play equipment in good condition. LPA observed a detached garage in the back yard. Per licensee the detached garage is used for storage. The home has a swing set and trampoline in the backyard. Per licensee only children ages 6 and up use the trampoline.

Kitchen: The kitchen in made inaccessible by a door with a child proof covering on the knob. Sharp utensils (in kitchen drawer) are inaccessible to children. LPA reminded licensee If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. Cleaning supplies are inaccessible under the sink. No chemicals in the kitchen were observed to be accessible. Per licensee, she serves the children breakfast, lunch, and dinner. According to the licensee snacks are provided if necessary.

Advisory/Other: First Aid kit was readily available (in kitchen). CPR/First Aid expires on 03/24. Mandated Reporter was completed 07/23/21. Child nap on mats and cribs in the on-limit bedrooms.

Documents discussed and emailed to licensee: Safe Sleep PIN 20-24-CCP, LIC 9227, Infant Sleep Log and Large Family Child Care ratios. During the visit LPA Dorsey discussed these documents with Assistant Hakob Boyajyan due to the licensee conducting children pick-ups.

Assistant Hakob Boyajyan was reminded that all adults 18 and over living or working in the home, 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.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: BOYAJYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700561
VISIT DATE: 09/15/2022
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LPA discussed the safe sleep regulations with Assistant Hakob Boyajyan 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 Assistant Hakob 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.

A notice of site visit was given and must remain posted for 30 days

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted. Report and Appeal rights were reviewed with Assistant Hakob Boyajyan due to the licensee conducting children pick-ups. Due to technical difficulties this report, appeal rights and notice of site visit was emailed to the licensee.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3