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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700744
Report Date: 10/05/2023
Date Signed: 11/09/2023 10:52:52 AM

Document Has Been Signed on 11/09/2023 10:52 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:MARTIROSYAN FAMILY CHILD CAREFACILITY NUMBER:
197700744
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
10/05/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Applicant Arpi Martirosyan TIME COMPLETED:
03:20 PM
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On 10/05/23, Licensing Program Analysts (LPAs) Andrew Alemoh and Evelyn Garcia conducted an announced inspection for the purpose of conducting Family Child Care Home pre-licensing inspection for a Small Family Child Care Home. LPAs was greeted by appilicant who guided the LPA on a tour of the facility.

Applicant will operate Monday-Friday hours 8:00am-5:30pm. The applicant will not be participating in a food program and applicant will provide breakfast, am/pm snacks and dinner if needed.



This is a two story family home which consist of four bedrooms, three restrooms, a kitchen, dining room, living room, attached garage and back yard and front yard. Dining room (child care area) and den will be the primary location in which care is provided referred to as the Child Care Play area and nap room. Children will utilize the restroom located to the right from the main entrance of the day care. Children will be provided with cots and infants will be provided with play pens for nap time. The off-limit areas are all bedrooms, 2 bathrooms, garage, (safety door knob observed) and attached garage (key locked).
The back yard is fenced all around and enclosed.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MARTIROSYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700744
VISIT DATE: 10/05/2023
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The home was inspected inside and out for safety, comfort, cleanliness, service, heating and center air ventilation. The home has age appropriate toys, play equipment and materials. The knives, medication and chemicals are kept in a kitchen drawer with magnet and child safety lock making them inaccessible to children. Applicant has a complete First Aid Kit with a thermometer in the child care area, which is stored inaccessible to the children .

Applicant was reminded about ensuring proper care and visual supervision at all times.

LPA observed a fire extinguisher (3A40BC) that meets the State Fire Marshal standards (reading in green) that is kept in the kitchen. LPA's observed the fire place to be barricaded and inaccessible to children which is in the dining area next to the kitchen. Applicant tested the smoke detector and carbon monoxide detector dual was found to be in operating condition according to the Fire Marshal standards. Per applicant there are no weapons or firearms in the home, nor did LPA observe any weapons or firearms during the inspection. The stove in the kitchen was observed to have stove safety knobs making those knobs inaccessible to children.



There is a pool on the premises that has a metal gate with mesh covering. At the time of inspection the gate and mesh measured 4' 7. LPA Alemoh will follow up with an LPM in regarding the pool fencing and regulations and will return at a later date to inspect the pool fencing.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023
LIC809 (FAS) - (06/04)
Page: 2 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MARTIROSYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700744
VISIT DATE: 10/05/2023
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The Licensee Pediatric CPR/First Aid expires on 7/15/25. The Licensee had the required immunization against pertussis (Tdap), measles (MMR), and tuberculosis (TB). Family Child Care Orientation was completed 4/22/23. Preventative Health and Safety training with lead and nutrition component is dated 7/23//2023. Child Care Provider Mandated Reporter training is dated 7/22/2023.

Applicant will have the parent board and other Licensing required forms at the entrance of the day care, visible to parents.

The following was discussed with applicants:

Infant safe sleep PIN, Infant Safe Sleep Plan(LIC9227) and safe sleep log were provided.

Mandatory licensing forms for the children’s files, facility forms/records, and information to be posted in the family child care home; Requirements to conduct fire and disaster drills once every six months and record it; Role and responsibilities of being a mandated reporter were reviewed; Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care; Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified; Regulation prohibits the smoking of any kind in the family child care home.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023
LIC809 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MARTIROSYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700744
VISIT DATE: 10/05/2023
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The Applicant was informed that all adults living in or having access to the home, or employees are required to have fingerprint clearances with Department of Justice, FBI and Child Abuse Central Index prior to having contact or working with children. If the aforementioned is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately. Please advise your analyst of any person who will be visiting regularly or for longer than one week. The applicant was advised to utilize the Request for Live Scan Service form LIC9163 to have adults fingerprinted and associated to the home.

The Applicant was advised of the requirement to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The applicant was informed to utilize the Unusual Incident Report/Injury Report form LIC624B when submitting the report to the department.

The Applicant was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months and licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian and place it in each child's file.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023
LIC809 (FAS) - (06/04)
Page: 4 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MARTIROSYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700744
VISIT DATE: 10/05/2023
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Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports (LIC 9224). If these requirements are not met civil penalties per violation will be assessed.

Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicants must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required.

The training may be conducted at the following website www.mandatedreporterca.com. This certificate is valid for two years.

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 applicant was advised it is her responsibility to visit the department's website to access licensing forms, Quarterly Updates and Provider Information Notices (PINs): www.ccld.ca.gov
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023
LIC809 (FAS) - (06/04)
Page: 5 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MARTIROSYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700744
VISIT DATE: 10/05/2023
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Child Care Advocates:
To sign up for our Quarterly Updates and Provider Information Notices (PINs), please subscribe online: http://www.cdss.ca.gov/inforesources/Community-Care-Licensing/subscribe

The following was provided to the licensee: All licensing forms required in children's files; All licensing forms required in the facility; All licensing forms to be posted in the home; Fire and Disaster Drill log; California Car Seat Flyer; Safe Sleep Flyer; Parent Notification Requirements; and Safe Sleep-in Child-Care brochure; and additional resources for the applicant and her Family Child Care Home.



LPA Alemoh is currently waiting on the following corrections:
AC unit cover.
An pool inspection will be conducted at a later date to inspect the pool fencing.

An exit interview was conducted, and a copy of this report was provided to the applicant All Licensing reports are recommended to be kept on file for minimum three years.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023
LIC809 (FAS) - (06/04)
Page: 6 of 7