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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019397
Report Date: 08/04/2021
Date Signed: 08/04/2021 06:37:11 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 08/04/2021 06:37 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:SARGSYAN FAMILY CHILD CAREFACILITY NUMBER:
198019397
ADMINISTRATOR:SARGSYAN, HAYKFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 471-3292
CITY:TUJUNGASTATE: CAZIP CODE:
91042
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/04/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Suyziia GyozalyanTIME COMPLETED:
12:20 PM
NARRATIVE
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On 8/4/2021, Licensing Program Analyst (LPA) Carol Heath met with the licensee, Suyziia Gyozalyan 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 0 children in care. There are only 1 child enroll this facility.

Currently residing in the home are the licensee, her spouse, her daughter (12 years) and Son (6 years). LPA toured the home inside and out Per LIS, facility annual fees are current. This facility operates from 7:00 Am to 7:00 PM Monday- Saturday. Incidental Medical Services (IMS) policy was discussed.

The home is set up as follows:

This is a single-story The home is a 2 bedrooms, 2 bathrooms home with a converted garage and a back yard. Off limit areas include the backyard, the two bedrooms, and the bathroom located in the master bedroom. The converted garage has been turned into a playroom. The backyard is completely fenced in. The home is clean, orderly, comfortable, and well ventilated. Licensee's poisons, detergents, cleaning compounds, medications, and other items which could pose a danger to children are stored under the sink with locks.
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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Document Has Been Signed on 08/04/2021 06:37 PM - It Cannot Be Edited


Created By: Carol Heath On 08/04/2021 at 11:18 AM
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: SARGSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198019397

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/09/2021
Section Cited
HSC
1596.8662

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Mandated Reporter Training: On and after January 1, 2018, a person who becomes an administrator or employee of a licensed child day care facility shall complete the mandated reporter training... (a) within the first 90 days that he or she is employed at the facility and shall complete renewal mandated reporter training every two years following the date on which she completed the initial mandated reporter training.
This requirement is not meet as evidenced by:
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The Licensee Suyziia agreed to take the online Mandated Reporter training by 8/9/2021 and the licensee will email to LPA her certification.
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Based on observation, interview and record
review, the licensee Suyziia did not complete the Mandated Reporter online training. Which poses an poses 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


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: SARGSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198019397
VISIT DATE: 08/04/2021
NARRATIVE
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Main care is proved in the playroom (Garage), front yard and front bedroom. Children use the Bathroom located in the front bedroom. Off limit areas include kitchen, living room, Bedrooms #1 and #2, Bathrooms #2, , 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 area): 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: 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 has a cover on the top which made it inaccessible to the children.

There is a fireplace located in the living room which is properly screened and meets all safety requirements. The home has central AC and heat. Per licensee, there are no weapons or firearms on the premises. LPA observed there is a required fire extinguisher on (3A40BC). LPA and the Licensee were discussed the required Fire extinguisher (2A10BC). The Fire extinguisher is located outside the Playroom. The smoke detectors and carbon monoxide devices tested operable. LPA did not observed the First Aid Kit.
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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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: SARGSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198019397
VISIT DATE: 08/04/2021
NARRATIVE
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The Licensee is not providing Incidental Medical Services. Incidental Medical Services (IMS) policy was discussed with the Licensee. 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 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 (03/2022 for Hayk S.) and 12/2022 for (Suyzila Gyozalyan), 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 3/12/2022 (Hayk Sargsyan) and did not observe (Suyzila Gyozalyan).
· Licensee will provide transportation for children if the family is needed.
· LPA reviewed 1 child the records are complete.
· Per the licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and conducted on Last month.
· LPA observed the Facility Roster. Per Licensing Information System, facility annual fees were current.
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: SARGSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198019397
VISIT DATE: 08/04/2021
NARRATIVE
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· 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.

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 LIC624B
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: SARGSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198019397
VISIT DATE: 08/04/2021
NARRATIVE
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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).
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
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: SARGSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198019397
VISIT DATE: 08/04/2021
NARRATIVE
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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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