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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018532
Report Date: 08/04/2021
Date Signed: 08/04/2021 06:39:29 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 08/04/2021 06:39 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:PETROSYAN HOVSEPYAN FAMILY CHILD CAREFACILITY NUMBER:
198018532
ADMINISTRATOR:PETROSYAN, RIMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 500-0424
CITY:TUJUNGASTATE: CAZIP CODE:
91042
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
08/04/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:33 PM
MET WITH:Rima Petrosyan and Sona HovsepyanTIME COMPLETED:
04:02 PM
NARRATIVE
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On 8/4/2021, Licensing Program Analyst (LPA) Carol Heath met with the licenseese, Rima Petrosyan and Sona Hovsepyan who granted access into the home. The purpose of the inspection is to conduct an unannounced Required 1 Year inspection at the above facility. Licensee is licensed to provide care and supervision for a large family child care for the capacity of 14 children. During the time of this inspection, the licensee had 12 children and 2 assistants (Sona, Haykanush) in care. Children were observed to be actively playing in the playroom. There were 1 children under the age of 2 years old, children between the ages of 3 to 5 years, and 0 school-age observed to be on the premises.

Currently residing in the home are the licensee, her spouse, and her daughter (25 years old). LPA toured the home inside and out Per LIS, facility annual fees are current. This facility operates Monday- Friday from 9:00 AM to 5:00 PM. Incidental Medical Services (IMS) policy was discussed.

The home is set up as follows:

This is a single-story home with 3 bedrooms, 2 bathrooms with kitchen/dining area, living room, patio, and backyard. There is no pool/spa or body of water on the premises. Incidental Medical Services (IMS) policy was discussed.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE: DATE: 08/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2021
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: PETROSYAN HOVSEPYAN FAMILY CHILD CARE
FACILITY NUMBER: 198018532
VISIT DATE: 08/04/2021
NARRATIVE
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Main care is provided living room, front bedroom and front yard. Children use the Bathroom located in the front bedroom. Off limit areas include Bedrooms #2 and #3, Bathrooms #2, kitchen (with safety gate), and Backyard. 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.

Kitchen (Off-limit): The kitchen was inspected to ensure hazardous items were inaccessible to children. All cabinets in the kitchen were inspected and are free of dangerous items. The licensee keeps knives and other sharp objects such as (scissors) on an upper cabinet shelf. All cleaning compounds/detergents are stored in the garage so that they are inaccessible to children.

Backyard (Off-limit): The backyard is fenced. Children have no access to the backyard area. Children play in the front yard, which is completely fenced. AC/Heating unit is on the top of roof which made it inaccessible to the children.

Per licensee, there are no weapons or firearms on the premises. LPA observed there is a required fire extinguisher on (2A10BC) and it had refill January, 2021. The Fire extinguisher is located in the living room. The smoke detectors and carbon monoxide devices tested operable. The First Aid Kit was observed complete with supplies and a first aid manual in the living room.

The Licensee is not providing Incidental Medical Services. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021
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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: PETROSYAN HOVSEPYAN FAMILY CHILD CARE
FACILITY NUMBER: 198018532
VISIT DATE: 08/04/2021
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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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm


· LPA observe licensee has current Pediatric CPR and First Aid Training with expiration date (2/3/2023) 1 hour of nutrition training, (8) hours of Preventive Health and Safety Training.
· The licensee has the required immunization. The licensee provided a written statement declining the influenza vaccination.
· The licensee has completed the online mandated reporter training at www.mandatedreporterca.com, and will renew 7/19/2023 (Rima) and
· Licensee does not provide transportation for children.
· LPA reviewed 6 children's and 1 assistant records, the records are complete.
· Per the licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and conducted on 3/22/21.
· LPA observed the Facility Roster. Per Licensing Information System, facility annual fees were current.
· Licensee has posted as required the Facility License, Emergency Disaster plan, and Parents Rights Poster. The facility roster is not current. there are no current facility earthquake/fire drills documents observed during the time of this inspection.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021
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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: PETROSYAN HOVSEPYAN FAMILY CHILD CARE
FACILITY NUMBER: 198018532
VISIT DATE: 08/04/2021
NARRATIVE
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The following information was discussed with the licensee:
ü Mandatory Forms for the children’s files and provider’s files.
ü Requirements for fire drills, earthquake drills, and documentation for both.
ü The role and responsibilities of being a mandated reporter were discussed.
ü The licensee is reminded that 100% supervision is required for children at all
times.
ü Capacity requirements, Roster requirements, Posting requirements, Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children’s files and provider’s files, and Safe Sleep Awareness. The role and responsibilities of being a mandated reporter were reviewed. The licensee was reminded that supervision is always required for children in care.
ü Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility’s phone number; if the phone number is changed, licensing must be notified.
ü 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 LIC 624B
ü The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000. Also, call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021
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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: PETROSYAN HOVSEPYAN FAMILY CHILD CARE
FACILITY NUMBER: 198018532
VISIT DATE: 08/04/2021
NARRATIVE
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ü The licensee was informed that the presence of adults in the home without Criminal Record Clearance or Exemption will be cited and civil penalty assessed for $100 per day. The licensee may find additional information and forms on the DSS website at www.ccld.ca.gov including information on the Live Scan application (LIC 9163). Appointments can be made for Live Scan at 1-800-315-4507
ü The regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers, and any other items that fall into that category.
ü --Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.
n Our Quarterly updates come out every 3 months they are also now in Spanish please log in to the CCLD website or you can email our advocates to have the quarterly updates send directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov
ü The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 AM - 5:00 PM.
ü A copy of the Safe Sleep Proposed Regulations was provided to Licensee.
ü LPA provided consultation during the inspection.

The following Type B deficiencies were cited in accordance with Title 22 of the California Code of Regulations and/or Health & Safety codes.

Exit interview conducted with Licensee. A copy of this report is discussed and left with the licensee.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/04/2021 06:39 PM - It Cannot Be Edited


Created By: Carol Heath On 08/04/2021 at 02:18 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: PETROSYAN HOVSEPYAN FAMILY CHILD CARE
FACILITY NUMBER: 198018532

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/06/2021
Section Cited
HSC
1596.8662(b)(2)

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1596.8662(b)(2):On and after January 1, 2018, a person who applies for a license to be a provider of a child day care facility ... shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
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The licensee agreeed to take a mandated reporter training by 8/6/2021. The licensee will email her certification to LPA after she completes the training.
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This requirement is not met as evidence by:
Based on observation and interviews, the
licensee did not complete mandated reporter training. which poses an immediated Health, Safety or Personal Rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Claretta Yates
LICENSING EVALUATOR NAME:Carol Heath
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2021


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