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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020587
Report Date: 07/13/2022
Date Signed: 07/13/2022 02:40:25 PM

Document Has Been Signed on 07/13/2022 02:40 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:GIESOGIAN FAMILY CHILD CAREFACILITY NUMBER:
198020587
ADMINISTRATOR:NAZIK GIESOGIANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 993-8989
CITY:PASADENASTATE: CAZIP CODE:
91104
CAPACITY: 14TOTAL ENROLLED CHILDREN: 15CENSUS: 10DATE:
07/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Nazik Giesogian, LicenseeTIME COMPLETED:
03:00 PM
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ANNUAL INSPECTION CONDUCTED IN ARMENIAN
Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced annual inspection to the above facility on 07/13/2022. LPA arrived at the facility at 12:00 PM and met with Nazik Giesogian, Licensee who guided analyst on a tour of the facility. Also present during this inspection, was Vatse Baltagian, Licensee’s Assistant. Per licensee, facility hours are Monday to Sunday from 7:00 a.m. to 10:00 p.m. LPA provided a copy of Entrance Checklist—Family Child Care Home (LIC126) to licensee.

This is a one story home located on the first level which consists of 3 bedrooms, 2 bathrooms, kitchen, dining room, living room (FIREPLACE: inaccessible), basement, garage (storage area) and backyard (fenced). Per licensee the children use the living room (dayare area), dining room, 1 bathroom in the hallway of bedrooms, kitchen, and backyard (fenced). Per licensee areas off limits to children and parents include: 3 bedrooms, one bathroom, basement, back of backyard and garage (storage area) . During this inspection individuals who reside in the home were discussed and notes on Confidential Name List (LIC811) and attached to this report. LPA did not observe any stairs in the home.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. At 12:00 p.m., Licensee took this LPA on a tour of the home. LPA was toured through the interior starting with the living room (daycare classrooms), LPA observed children's table, chairs, and toys in the living room room. LPA observed all electrical outlets were covered in living room. LPA observed 10 children were present in the living room with licensee and her assistant. Next LPA toured the dining room and observed two sofas, a dining table, chairs in the dining room. LPA observed a safety gate was installed between living room and dining room. Next LPA toured the kitchen and observed child proof safety latches on the cabinets where licensee stores sharp items and cleaning compounds. Per licensee children only talk through the kitchen to go to the backyard. LPA observed a safety
REPORT CONTINUES ON NEXT PAGE 1 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GIESOGIAN FAMILY CHILD CARE
FACILITY NUMBER: 198020587
VISIT DATE: 07/13/2022
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gate was installed to the kitchen one entrance and per licensee she keeps the kitchen door closed all the times. Next LPA toured the daycare bathroom and observed child proof safety latches on the under the sink cabinet where licensee stores cleaning compounds. LPA observed a safety gate was installed in the hallway of off-limit bedrooms to make the off-limit areas inaccessible to the children. Next LPA toured the off-limit three bedrooms and one off-limit bathroom and did not observe any hazards. LPA observed licensee's and her family members personal belongings in the home. LPA observed the required 2A 10BC fire extinguisher was anchored to the wall in the kitchen. It was purchased on 07/12/2022 as read by LPA from the receipt. Licensee tested the carbon monoxide detector in the hallway of bedrooms and smoke detector in the living room. Both sounded off the alarms and heard by LPA to be functional. Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock.

Next LPA toured the backyard fenced. Currently, children are using the back yard for outdoor play time. LPA observed that the outdoor yard has toys and other materials for children to play with. Per licensee children walk through the dining room and kitchen to go to the backyard. LPA observed off-limit area of backyard was separated by safety gate to be inaccessible to the children. LPA observed the outdoor playarea ground is cement and artificial grass. LPA did not observe any objects that can pose a danger to children on the outdoor yard. The licensee states that supervision is always provided. Next LPA toured the off-limit garage (storage area) and did observe any hazards. Per licensee the garage door is kept closed all the times.

Per Licensee, at 1:00 p.m there are no pets, weapons, firearms, pools, spas, hot tubs, fish ponds, or similar bodies of water on the premises.
The licensee was observed to be operating within the licensed capacity and is not exceeding the required limitations during this inspection. During this inspection 10 children were present in the facility with licensee and her assistant. All adults present have obtained a criminal record clearance on Licensing Information System (LIS). Per licensee, currently she has three assistants. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
REPORT CONTINUES ON NEXT PAGE 2 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022
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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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GIESOGIAN FAMILY CHILD CARE
FACILITY NUMBER: 198020587
VISIT DATE: 07/13/2022
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The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 06/2023. Licensee did have current required mandated reporter training certificate during this inspection, it was completed on 03/2020 which is required to be renewed every two years. There are first aid supplies available on the premises. LPA advised licensee that if a child shows signs of illness he/she/they shall be separated from other children.

At 1:10 p.m., facility roster was reviewed and completed. Per licensee currently there are 15 children enrolled. LPA reviewed 10 children's records, including emergency information from 15 enrolled children, and all 10 reviewed files were completed. The licensee and her assistants have proof of immunization against influenza, pertussis, and measles. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Last drill documented was conducted on 06/10/2022. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted at the wall by the entrance.
LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home. There is telephone service via a cellphone that is used and the cellphone stays at the facility during operation hours. Per licensee she does not carry liability insurance or a bond in accordance with standard established by Family Child Care statue. Signed statements (LIC282) on 10 reviewed files.
INFANT CARE: Licensee states that she only care for infants over one year old. Licensee states that infants sleep in the living room where they are constantly supervised. Appropriate sleeping arrangements and cribs will be available if under one year old infant be present . (one crib for each infant in care is required). Cribs or play yard shall not hinder the entrance or exit from the sleeping space, mattresses shall be firm and covered with a fitted sheet that overlaps the underside so it cannot be dislodged. Cribs and play yards shall be free of loose articles and objects. No objects shall be hanging above or attached to the side of the crib. LPA did not observe any infants swaddled while in care. LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. A copy of the LIC 9227 was provided to Licensee. LPA provided the licensee with a copy of A Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. LPA also consulted and explained Child Abuse Reporting, Never Shake a Baby, and Safe Sleeping practices.
REPORT CONTINUES ON NEXT PAGE 3 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022
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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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GIESOGIAN FAMILY CHILD CARE
FACILITY NUMBER: 198020587
VISIT DATE: 07/13/2022
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SAFE SLEEP: LPA discussed the safe sleep regulations with licensee, and discussed the Child Care Licensing Safe Sleep webpage at http://www.cdss.ca.gov/inforescources/child-care-licensing/public-information-and-resoucrces/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 http://www/cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. Boppy recall: https://www.cpsc.gov/Recalls/2021/The-Boppy-Company-Recalls-Over-3-Million-Original-Newborn-Loungers-Boppy-Preferred-Newborn-Loungers-and-Pottery-Barn-Kids-Boppy-Newborn-Loungers-After-8-Infant-Deaths-Suffocation-Risk
Medication: Incidental Medical Services (IMS) policy was discussed. The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. 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.

LPA advised the licensee to access forms, regulations and quarterly updates online at: www.ccld.ca.gov.

The following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.
The Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experienced. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding inspection tools and methods, please visit the Program website at www.cdss.gov/inforesouces/community-care-liceinsing/inspection-process
Exit interview conducted and report was reviewed with the Licensee, Nazik Giesogian at 3:00 p.m..
REPORT END 4 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/13/2022 02:40 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 07/13/2022 at 12:53 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GIESOGIAN FAMILY CHILD CARE
FACILITY NUMBER: 198020587

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/13/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on licensee file review, the licensee did not comply with the section cited above and did not have current required mandated reporter training certificate, it was expired 03/2022 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/29/2022
Plan of Correction
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Per licensee, she will complete required mandated reporter training by plan of correction due date 07/29/22 and send a copy to LPA Eivazian via email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Christina Gabelman
LICENSING EVALUATOR NAME:Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2022


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