197700576-8-2-2022-12-CC-JTAO-CGWTDQ-20220802143843

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700576
Report Date: 08/02/2022
Date Signed: 08/02/2022 03:58:14 PM

Document Has Been Signed on 08/02/2022 03:58 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:	AGHASARYAN FAMILY CHILD CARE		FACILITY NUMBER:	197700576
ADMINISTRATOR:	LUISINE AGHASARYAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 679-8894
CITY:	SANTA CLARITA	STATE: CA	ZIP CODE:	91350
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	08/02/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Luisine Aghasaryan, Applicant		TIME COMPLETED:	02:50 PM

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On 08/02/2022, Licensing Program Analysts (LPAs) Justeene Tamayo, Barbara Beneroso, and Andrew Alemoh conducted a Pre-licensing Inspection with Applicant Luisine Aghasaryan who guided LPAs on a tour of the facility.

This is a one-story house with 3 bedrooms, 2 bathrooms, living room, kitchen, laundry room area, front yard, backyard, and garage. Family members residing in the home include 2 adults (applicant and applicants daughter).

The facility will operate Monday through Friday from 6:30AM-6:30PM for less than 24 hours and with a license capacity of 14 children. LPAs went over the child care ratios for a large family home with applicant, and provided applicant a copy.

Main care will be provided in the living room area. Children will eat in the living room area. Per applicant, she will be utilizing a food program. The day care children will utilize the hallway bathroom on the left hand side. Children will use the front yard for outdoor play. The backyard, all bedrooms, bathroom #2, laundry room, and garage area are off limits to the day care children.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022

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: AGHASARYAN FAMILY CHILD CARE	FACILITY NUMBER: 197700576
	VISIT DATE: 08/02/2022

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Applicant was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within 24 hours of incident by telephone and in writing within 7 day of incident to the department. Applicant was informed all suspected Child Abuse should be reported to the Child Abuse Hot-line at 1-800-540-4000. The above incident should be reported on the form LIC624B per the regulation. The form should be email to unusualincidentreport@dss.ca.gov

Advisory/Other: LPAs observed a first Aid kit with emergency supplies and a thermometer in the main care area. Applicant First Aid/CPR are current. Preventative Health & Safety training is completed. Electrical outlets are inaccessible to children. Children will nap on cots in the main care area. Applicants aware no infant shall be swaddled, and car seat shall not be used for sleeping. Applicant is aware to supervise infants while they are sleeping by physically checking every 15 minutes and documenting the infant’s status. Applicant should refer to regulation 102425(J) for documentation requirement. If the infant’s Individual Infant Sleeping Plan [LIC 9227 (3/20)] does not have Section C completed, the provider shall return the infant to their back for sleeping. LPAs discussed the safe sleep regulations with applicant, including Safe Sleep PIN 20-24-CCP 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. LPAs 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.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022

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: AGHASARYAN FAMILY CHILD CARE	FACILITY NUMBER: 197700576
	VISIT DATE: 08/02/2022

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LPAs observed day care area to be clean and orderly, fireplace screened in main care area, there is central air and heating, age appropriate toys and play equipment, working smoke detector and carbon monoxide detector.

LPAs did not observe any hazardous items in the child care bathroom. LPAs reminded applicant the children's bathroom must be free of shampoos, mouthwash, medication, perfumes, razor, air freshener, nail polish and polish remover. LPAs observed a clean, safe and operable toilet and faucet.

LPAs observe a fully charge 2A10BC fire extinguisher during the inspection located in kitchen area. First aid kit is also stored in the main care area. LPAs observed medications located in the upper kitchen cabinet inaccessible to children in care.

Applicant made poisons and cleaning items inaccessible to children stored in garage (off limits). Day care children cannot access the kitchen,laundry room, backyard, and garage by the barricaded gate in the main care area.

Kitchen: The following are inaccessible: Sharp items are stored in the upper kitchen cabinet next to the stove unreachable to children in care. LPAs observed the refrigerator and freezer to be clean. All alcohol in the home is inaccessible to children in care. LPAs discuss with applicant food shall be properly stored or refrigerated in container that are labeled with child’s name when supplied by parent. Applicant plans to have a food program.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022

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: AGHASARYAN FAMILY CHILD CARE	FACILITY NUMBER: 197700576
	VISIT DATE: 08/02/2022

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Applicant inform smoking is prohibited, applicant stated no one smokes in the home, LPAs discussed Health Section 1596.846(b) and (c)–102417 (g)(10) and provided applicant with a visual copy of prohibited items. LPAs did not observe prohibited items during the inspection. Per applicant no firearms are present in the home. Applicant was informed her cell phone shall be available and charged at all times during daycare hours.

Incidental Medical Services (IMS) policy was discussed, informing applicant when any IMS is provided, a plan for providing IMS must be submitted to the Department prior to providing care to a child that need IMS. The plan shall state the type of IMS the facility will be offering, stating the person providing care has been trained to provide the named IMS. The plan will also provide the steps that will be taken when IMS is provided to a child.

The following information regarding ADA was discuss and the following information 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

Exit interview conducted copy of this report was provided to applicant along with notice of site visit.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022

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: AGHASARYAN FAMILY CHILD CARE	FACILITY NUMBER: 197700576
	VISIT DATE: 08/02/2022

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LPAs toured the front yard and observe it to be free of garden tools, poisonous plants, thorn trees cactus, or lawn mower inaccessible to children.The front yard is completely barricaded with a black gate, including an access code and Ring Camera. LPAs observed play equipment in the front yard. Per applicant, she will be purchasing more play equipment for the front yard. Applicant states there are currently two dogs in the home.

Applicant 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.

Documents Provided and or Discussed: The following were provided to comply with Title 22 requirements: Fire Drill Log, roster, Safe Sleep PIN 20-24-CCP, Individual Sleeping Plan (LIC9227), water lead poster, required postings and list of CCLD forms required for child file each child in care (LIC 311D). Applicant stated currently does not have childcare insurance, but plans to. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022

LIC809 (FAS) - (06/04)

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