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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019397
Report Date: 01/10/2024
Date Signed: 01/10/2024 03:46:42 PM

Document Has Been Signed on 01/10/2024 03:46 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 CHILD CARE, 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: 14CENSUS: DATE:
01/10/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Suyziaa Gyozalyan, Hayk SargsyanTIME COMPLETED:
04:15 PM
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On Wednesday, January 10, 2024, 2:15 pm., Licensing Program Analyst (LPA) Evelyn Garcia conducted an unannounced inspection and met with licensee who guided LPA Garcia on a tour of the facility.
Family members residing in the home have been discussed with licensee and are cleared, they include licensee husband and two minor children. Operating hours are Monday to Sunday from 6:00 a.m. to 9:00 p.m. and care for children ages 0 to 13 years old. The licensee stated she has 2 children enrolled but will not start until possibly next week. She has not had children present since she was doing construction. There are no children in care at the time of the visit.

This facility is a single-story home that consists of 3 bedrooms, 3 bathrooms, kitchen, living room, dining room, side garage, and front and backyard fenced.

Areas off limits to children include- All 3 bedrooms, 2 bathrooms, Livingroom, backyard, garage. Areas accessible to children include the dining room, bathroom adjacent to entrance of the home, and front yard. The children mostly utilize the dining room as the daycare area.

LPA Garcia inspected the facility for safety, comfort, cleanliness, ventilation and working phone (cell phone). For ventilation, LPA Garcia observed central AC and the vents located on the ceiling. LPA observed the furniture, children’s materials, to be in good condition and age appropriate. LPA did observe a fireplace that has a metal screen to prevent accessibility. For napping licensee states she will purchase cots and cribs, however at the moment she is only caring for school aged children.

LPA Garcia observed cleaning compounds items, knives and sharp objects stored inside the bottom kitchen sink cabinet. LPA reminded licensee that when children are present or during operating hours, all safety latches, locks must be secured to prevent accessibility to cleaning compounds and other hazards, including shampoos, conditioners, and mouthwashes. For water drinking, licensee stated she provides water bottles and filtered water and use disposable cups and utensils. The licensee stated the facility provides lunch and p.m. snacks or meals as needed.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2024
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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SARGSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198019397
VISIT DATE: 01/10/2024
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 LPA informed licensee any food brought from the children's homes, the container shall be labeled with the child's name and properly stored or refrigerated. Licensee stated she currently does not have any children with severe food allergies nor on medication.

LPA Garcia entered the bathroom and observed the toilet, hand washing sink, hand soap and LPA observed the bottom sink cabinet closed however no safety latch with no hazard materials and observed the restroom to be in good condition. LPA reminded licensee to keep hazard materials under safety latch or lock.

LPA Garcia asked the licensee if there were any pets, poisons, firearms, weapons, or bodies of water. The licensee stated she has no pets, no poisons and no bodies of water, no firearms, and no weapons. LPA did not observe pets, poisons, firearms, weapons, nor bodies of water. The license was informed 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 must be stored separately.



LPA Garcia observed the required 2A10BC fire extinguisher located in the daycare hallway and the valve on the green area indicating fully charged. LPA observed carbon monoxide detector and smoke alarm located in the daycare hallway. Licensee tested the carbon monoxide and smoke alarm. LPA Garcia heard the sounds and are operable. LPA observed the first aid complete with band aids, gauzes, adhesive bandages, and antiseptic wipes and located in the daycare hallwayt. For ill isolation, licensee stated she utilize a corner of the daycare room. Last drill conducted 10/12/23.

LPA Garcia inspected the play outdoor (front yard) area that is utilized by children for safety, comfort, and cleanliness. LPA observed the backyard to be fenced and gates closed and with a electronic keypad for safety. LPA observed the play equipment to be age appropriate and in a safe condition, free of sharp, no lose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. For outdoor water drinking, children bring out their water bottles.

LPA Garcia observed licensee Pediatric First Aid/ CPR certification dated 6/10/23 and 6/10/23 and Health and Safety certification dated 5/27/17 and 4/22/17. Licensee states she sent another LPA proof of immunization against Pertussis, MMR and Influenza declination, however at the moment she cannot locate them. Licensee will send to LPA Garcia when she obtains copies from her doctor. Licensee has completed the Child Abuse Mandated Reporter (AB 1207) training dated 7/11/22 and 8/6/23. Licensee was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SARGSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198019397
VISIT DATE: 01/10/2024
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LPA observed the required postings License, LIC 610A Emergency Disaster Plan, Pub 394 Notification of Parents Rights, LIC 999 Facility sketch, and child car seat law poster. LPA also, reviewed children roster, children files and staff files. LPA observed the files to up be complete.

The following was also discussed with the licensee:



1. In the absence of the licensee 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.

2. 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.

4. 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.

5. 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.

6. 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.



7. 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.

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

9. Smoking is prohibited in the family childcare home.



10. Children and staff records must be maintained and updated as needed and be available for review by the Department.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SARGSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198019397
VISIT DATE: 01/10/2024
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11. 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.

12. 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.



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

14. 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).

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

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

14. 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.



To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, 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.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SARGSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198019397
VISIT DATE: 01/10/2024
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LPA discussed the safe sleep regulations with licensee and 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 licensee 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; 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.

Licensee expressed interest in providing overnight care in the future. LPA went over, overnight care regulations with the licensee and asked her to contact LPA or Palmdale Regional Office if she begins to provide overnight care.

During the exit interview, the licensee Suyziaa Gyozalyan, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Suyziaa Gyozalyan.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
LIC809 (FAS) - (06/04)
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