197700874-12-6-2024-12-CC-MRIA-DBPTX8-20241206140642

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700874
Report Date: 12/06/2024
Date Signed: 12/06/2024 02:06:59 PM

Document Has Been Signed on 12/06/2024 02:06 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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	KHACHIKYAN FAMILY CHILD CARE		FACILITY NUMBER:	197700874
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	12/06/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:25 AM
MET WITH:	Inessa Khachikyan, Applicant		TIME VISIT/ INSPECTION COMPLETED:	02:15 PM

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On Friday, December 6, 2024, Licensing Program Analyst (LPA) Mayra Rivera conducted an announced pre licensing inspection and met with applicant Inessa Khachikyan who granted access and guided LPA Rivera on a tour of the facility. The applicant is a change of location and requesting the large license for 14.

Family members residing in the home has been discussed with applicant and are cleared. Operating hours will be Monday to Saturday from 7:00 a.m. to 10:00 p.m. and care for children ages 0 to 13.

This facility is a two-story home that consists of 4 bedrooms, 3 bathrooms, kitchen, living room, dining room, laundry room, family room (daycare) and front and backyard fenced and in-ground spa.

Areas off limits to children include- All second floor, 3 bedrooms, 2 bathrooms (upstairs), kitchen, living room, dining room, laundry room and in-ground spa.

Areas accessible include- family room (daycare), bedroom located in daycare room, bathroom located in the daycare room and backyard.

LPA Rivera inspected the facility for safety, comfort, cleanliness, ventilation and working phone (cell phone). For ventilation, LPA Rivera observed central air conditioner/heater unit. LPA observed the furniture, children’s materials, to be in good condition and age appropriate. LPA observed 1 play yard to have a fitted mattress and free from bumper pads, pillows, blankets, and hanging items.

LPA Rivera observed cleaning compounds items stored in the laundry room and door with a magnetic childproof lock to make it inaccessible for children to enter. Applicant stated knives and sharp objects will be stored in top cabinet next to the refrigerator to make it inaccessible for children to reach. LPA observed the electric outlets to have covers. For water drinking, LPA observed a water dispenser and disposable/sippy cups. Applicant stated she will be providing the meals and snacks for the children. LPA informed applicant

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024

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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: KHACHIKYAN FAMILY CHILD CARE	FACILITY NUMBER: 197700874
	VISIT DATE: 12/06/2024

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food brought from the children's homes, the container shall be labeled with the child's name and properly stored or refrigerated.

LPA Rivera entered the restroom and observed the toilet, hand washing sink, hand soap and LPA observed the bottom sink cabinet closed and with a child proof lock. LPA did not observe hazard materials and observed the restroom to be in good condition. LPA reminded applicant any personal items (ex; shampoo, toothpaste, mouthwash, or items that fall into that category) must be made inaccessible to children.

LPA Rivera asked applicant if there are any pets, poisons, firearms, weapons, or bodies of water. Applicant stated she has 2 dogs (Pekingese and bull terrier), and in-ground spa. No poisons, no firearms, and no weapons. LPA did not observe the dogs, poisons, firearms, or weapons. Applicant was advised that if any poisons (ex; drano, rat poison or items that fall into that category), firearms and weapons are purchased, it is required to be locked with a key or combination lock and firearm and ammunition/ firing pins must be stored separately.

LPA observed the in-ground spa in the backyard. LPA observed the in-ground to be fenced all around and measured the height of the mesh fence from the ground up to the top of the fence to be 5.0 ft high and fence does not obscure the spa from view. The openings of the railings, LPA measured and observed the opening railing next to the gate to be 4.2 inches wide. LPA informed applicant the opening railing cannot exceed more than 4 inches. There is a step next to the gate. LPA measured the gate and observed the measurement to be 4.5 ft high. LPA informed; the gate needs to be at least 5ft high. One of the mesh walls near the plants, bottom opening is more than 2 inches on the soft surface. LPA informed applicant the opening cannot exceed more than 2 inches. LPA informed applicant about new AB-2866 Pool safety: State Department of Social Services regulated facilities. In addition to the fencing, applicant will need to install a spa/pool cover or an alarm that, when placed in a swimming pool, will sound upon detecting an entrance into the water. life ring with a minimum exterior diameter of 17 inches and labeled as approved by the United States Coast Guard. A rescue pole with a body hook and a minimum fixed length of 12 feet and applicant shall perform a daily inspection of the drowning prevention safety features and safety equipment before opening the facility and maintain a log of the inspections to be provided to the department upon request. LPA reminded applicant, the mesh fencing must not be removed and no ladders or any climbing equipment near the fencing. LPA informed applicant, if in the future the fencing needs to be replaced, applicant will need to contact the department to notify about the change.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024

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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: KHACHIKYAN FAMILY CHILD CARE	FACILITY NUMBER: 197700874
	VISIT DATE: 12/06/2024

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LPA Rivera observed the required 2A10BC fire extinguisher located in the laundry room with the valve on the green area indicating fully charged. LPA observed the purchased receipt dated 7/20/24. LPA observed a dual carbon monoxide detector and smoke alarm located near the daycare room. Applicant tested the dual carbon monoxide and smoke alarm. LPA Rivera heard the sound, and it is operable. LPA observed the first
aid complete with band aids, gauzes, adhesive bandages, and antiseptic wipes and located in the daycare room. For ill isolation, applicant stated she will be using a corner of the daycare room.

LPA Rivera inspected the play outdoor (backyard) area that will be utilized by children for safety, comfort, and cleanliness. LPA observed the backyard to be fenced and gated. LPA observed both gates closed and locked with a self-latch. LPA recommended to place a safety gate barrier on the right side of the side yard to prevent children entering the area. Area has blind spots due to the flower bushes. LPA also informed to place a cover on the bbq grill.

LPA observed applicant Inessa Emergency Medical Services Authority (EMSA) Pediatric First Aid/ CPR certification dated April 17, 2023, and Health and Safety certification dated April 21, 2023, and applicant has proof of immunization against Pertussis, MMR, and Influenza declination. The applicant has completed the mandated reporter training dated October 28, 2024.

Applicant stated she plans to care for infants 0-24 months old. LPA informed Applicant of the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months and 15-minute sleep check documentation for infants 0-24 months. LPA provided the LIC 9227 Individual Infant Sleeping Plan and Safe Sleep Log form.

During the inspection, LPA did not observe the required postings- Pub 394 Notification of Parents Rights, LIC 999 Facility sketch, and child car seat law poster. LPA informed applicants, the required posting need to be posted in the area where parent can view the information.

The following was also discussed with the applicant:

1. The following items are zero tolerance by Licensing: Refused Entry to a Facility or Any Part of a Facility is a violation of Section 1596.852, 1596.853 or 1597.09. Regulations 101238 (g) (2), The Presence of an Excluded Individual, Fire Clearance Violations, Accessible Bodies of Water, Accessible Firearms, Ammunition or Both.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024

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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: KHACHIKYAN FAMILY CHILD CARE	FACILITY NUMBER: 197700874
	VISIT DATE: 12/06/2024

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2 Pediatric First Aid and CPR: American Heart Association or American Red Cross or Emergency Medical Services Authority (EMSA) approved in Pediatric First Aid and CPR must be present. Certification must be renewed every two years.

3. Applicant was informed that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com

4. In the absence of the licensee 80/20 a qualified adult must be present, supervising the children; a qualified adult is an individual who has a valid and current Pediatric first aid/ CPR-adult-child- infant certification (EMSA approved), a valid criminal record clearance associated to the facility license, immunization's (MMR, TDAP, TB and Influenza or Influenza declination), AB 1207 Child Abuse Mandated Reporter Certificate.

5. A current roster of children enrolled must be available and maintained for a period of 3 years, even after children are no longer attending the facility.

6. Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the license shall be terminated

7. The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

8. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

9. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing (refer to LIC 624B). Mandated reporter requirements were reviewed and explained.

10. Fire and safety drills must be performed every six (6) months and documented for review by the Department.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024

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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: KHACHIKYAN FAMILY CHILD CARE	FACILITY NUMBER: 197700874
	VISIT DATE: 12/06/2024

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11. Smoking is prohibited in the family childcare home.

12. Children and staff records must be maintained and updated as needed and be available for review by the Department.

13. Immunization Requirement: H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. The licensee and all adults working with children have proof of immunizations.

14. Inspection Authority: All adults living and working in the home shall be made of aware of the Department’s right to inspection the home, which includes, but is not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

15. The facility license number must be on all advertisements, publications, or announcements with the intent to attract clients.

16. Isolation for Ill children: When a child is ill, he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home).

17. Liability Insurance was discussed; LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information.

18. Dog(s) and/or pets are recommended to be isolated from children in care.

19. No baby bouncers, no infant walkers, no Johnny jumpers, no saucer chairs, and any other item that falls into this category is not permitted in the facility.

Applicant Inessa Khachikyan was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

The applicant provided proof of control of property.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024

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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: KHACHIKYAN FAMILY CHILD CARE	FACILITY NUMBER: 197700874
	VISIT DATE: 12/06/2024

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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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) or (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

Review of records to be maintained - Family Child Care Homes LPA reviewed with Inessa Khachikyan, the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. LPA Rivera explained in detailed to applicant Inessa Khachikyan LIC 9221 Parent Consent for Administration of Medications and medication chart, LIC 9040 Child Care Facility Roster, LIC 624 Unusual Incident Report, LIC 9227 Individual Infant Sleeping Plan, Safe sleep practices, safe sleep log, the California Car Seat Law Changes (effective February 2018), Effects of Lead Exposure, Shaken Baby Syndrome, and Sudden Infant Death Syndrome (SIDS). Entrance Checklist was provided to the applicant.

LPA discussed the safe sleep regulations with applicant Inessa Khachikyan discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep,as an additional resource. LPA also informed Inessa Khachikyan 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.

On this date September 9, 2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024

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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: KHACHIKYAN FAMILY CHILD CARE	FACILITY NUMBER: 197700874
	VISIT DATE: 12/06/2024

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Applicant Inessa Khachikyan was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Subscribe to CCLD important information - Family Child Care Homes: Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Corrections needed: Add a gate barrier on the bottom of the stairs, spa gate must be at least 5ft high, the opening between railing (near gate door) needs to be less than 4 inches, and the bottom of the mesh wall soft opening less than 2 inches. Add a gate barrier to the right-side yard and place a cover on the BBQ grill. Due date 1/6/2025. Applicant has 30 days to make the corrections.

Exit interview conducted and report was reviewed with the Inessa Khachikyan.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024

LIC809 (FAS) - (06/04)

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