198020796-6-28-2021-33-CC-AEIN-C4EN5N-20210628100948

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020796
Report Date: 06/28/2021
Date Signed: 06/28/2021 10:10:03 AM

Document Has Been Signed on 06/28/2021 10:10 AM - 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:	FAZILIAN FAMILY CHILD CARE		FACILITY NUMBER:	198020796
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	06/28/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	07:50 AM
MET WITH:	Tamar A. Fazilian, Applicant		TIME COMPLETED:	10:20 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	PRELICENSING INSPECTION CONDUCTED IN ARMENIAN Licensing Program Analyst (LPA) Anomeh Eivazian conducted an announced pre-licensing inspection to the above facility on 06/28/2021. LPA arrived at the facility at 7:50 AM and met with Tamar Fazilian, Applicant who guided analyst on a tour of the facility. During this inspection individuals who reside in the home were discussed and notes on Confidential Name List (LIC811) and attached to this report.Per applicant operation hours will be Monday to Friday, 7:30 a.m. to 6:00 p.m.. Applicant states she will care for children 0-12 years old. All areas identified on the facility sketch were inspected. This is a two story home. The home consists of 5 bedrooms, 2 & 1/2 restrooms, living room, dining room, breakfast area, kitchen, front yard, backyard (fenced). There is a converted attached garage to additional room to the house that is connected to the main home from inside and it is consists of one room (daycare area) with it's own entrance. Attached converted garage adders is 3522 La Crescenta Ave. unite A, Glendale CA 91208. There is a fireplace in the living room which has been blocked off to prevent access to children. LPA obtained a copy of City of Glendale permit for converted attached garage to additional room, JR ADU. Areas that are accessible to children are as follows: Bathroom in the hallway of kitchen and converted attached garage to additional room (daycare area) and backyard (fenced). Areas off limits based on facility sketch submitted to children and parents include: Entire main home which consists of kitchen, living room, dining room, breakfast area, 5 bedrooms , two bathrooms, front yard, and off-limit area in the backyard. Rooms that are off-limits need to be made inaccessible during operating hours REPORT CONTINUES ON NEXT PAGE 1 of 5

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2021

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: FAZILIAN FAMILY CHILD CARE	FACILITY NUMBER: 198020796
	VISIT DATE: 06/28/2021

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The applicant states children will use the backyard (fenced) for outdoor activity. Per applicant children will be physically and visually supervised at all times. The applicant does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.

At 8:00 am, the applicant began touring LPA’s through the home starting with the entry way which lead directly to the living room. Per applicant children will not have the access to the main home which consists of living room, dining room, breakfast area, kitchen, three bedrooms in the first floor, 1 bathroom in the first floor, two bedrooms and one bathroom in the second floor. LPA observed a gate was installed by the kitchen and a gate was installed in the hallway of kitchen which leads to the living room to prevent access to the rest of the home. LPA observed applicant's family members personal belongings in the home. Next LPA toured the half bathroom in the first floor adjacent to the kitchen and did not observe any hazards. Next LPA toured the permitted converted garage to additional room (daycare area) and observed children toys, a TV, children table and chairs in the additional room. LPA observed converted garage to additional room is connected to the main home. Per applicant parents will use the entrance door which leads to the additional room (daycare area). Next LPA walked through the hallway of the home and went to the backyard (fenced) and observed children toys and playhouse in the backyard. LPA observed off-limit area in the backyard was separated by children safety gates. LPA observed the required 2A 10BC fire extinguisher was anchored to the wall in the hallway which leads to the backyard. It was purchased on 06/12/2021 as read by LPA from the receipt. Applicant tested the carbon monoxide and smoke detectors in the additional room (daycar area). It sounded off the alarms and heard by LPA to be functional. There are emergency supplies on the premises in the daycare area.

Applicant has proof of CPR and First Aid training as indicated on the certificate. The applicant does have proof of Health and Safety training (completion date: 01/18/2020) Lead Poising Prevention (LPP) training was completed on 02/22/2021, Pediatric First Aid and CPR (ex. 01/2022).

The following was discussed with the applicant:
Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
REPORT CONTINUES ON NEXT PAGE 2 of 5

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2021

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: FAZILIAN FAMILY CHILD CARE	FACILITY NUMBER: 198020796
	VISIT DATE: 06/28/2021

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-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 adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.
-A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
-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.
-The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should check and batteries replaced as needed.
-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.
-Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report)
-Fire and safety drills must be performed every six months and documented for review by the Department.
-Smoking is prohibited in a family child care home.
-Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
-Dog(s) and or pets are recommended to be isolated from children in care.
- No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.
-All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
- Applicant shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.
- Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.
Medication: Incidental Medical Services (IMS) policy was discussed .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

REPORT CONTINUES ON NEXT PAGE 3 of 5

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2021

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: FAZILIAN FAMILY CHILD CARE	FACILITY NUMBER: 198020796
	VISIT DATE: 06/28/2021

NARRATIVE

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INFANT CARE: Applicant states that she will care for infants. Applicant states that infants will sleep in the converted garage to additional room, daycare areawhere they are constantly be supervised. Appropriate sleeping arrangements and cribs will be available once an infant being enrolled. LPA informed one crib for each infant in care will be needed. Cribs or play yard did 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 informed Applicant infants can not be swaddled while in care. LPA advised the Applicant 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 Applicant. LPA provided the Applicant 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.

During this inspection LPA discussed PIN 20-06 CCP, Social And Physical Distancing Guidance And Healthy Practices For Child Care Facilities In Response To The Global Coronavirus (COVID-19) Pandemic Written In Collaboration With The California Department Of Education and reviewed Child Care Covid-19 Self Assessment.

Per applicant, there are no dual licenses at this address. Applicant’s email address was obtained during this inspection. The applicant was advised that email may be public information.

Per applicant, she does not carry liability insurance or a bond in accordance with standard established by Family Child Care statue. Signed statements (LIC282) will be on children’s files. The law requires Family Child Care provider to carry liability insurance or bond in the amount of $300,000 annually or to maintain the signed statement in the facility file.

The applicant does not have proof of immunization against influenza, pertussis, and measles.
Applicant completed required mandated reporter training on 03/09/2020. Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com

REPORT CONTINUES ON NEXT PAGE 4 of 5

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2021

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: FAZILIAN FAMILY CHILD CARE	FACILITY NUMBER: 198020796
	VISIT DATE: 06/28/2021

NARRATIVE

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LPA consulted and explained Child Abuse Reporting, Effects of Lead Exposure Flyer, Updated Patent’s Rights Poster with Complaint Hotline information, Capacity Handout (Small & Large) was provided during this inspection. LPA advised the applicant how to access forms, regulations and quarterly updates, and Provider Information Notices (PIN) on the Child Care Licensing website at: www.ccld.ca.gov. LPA reviewed and issued the Forms/Records to Keep in Your Family Child Care Home (LIC 311D) and provided the following forms:
CHILDREN FORMS/RECORDS , FACILITY FORMS/RECORDS , INFORMATION TO BE POSTED IN YOUR FAMILY CHILD CARE HOME

Final review of application will be completed by Regional Manager Deborah Ajao, Licensing Program Manager Christina Gabelman and LPA Eivazian prior to licensure.

LPA inquired into the applicant's practices related to COVID-19. Applicant stated that she practice hygiene such as hand washing with the children. Applicant has hand sanitizer available in the drop off area and inside her home. Applicant states they practice social distancing with children, take children temperature daily, applicant, staff and parents will wear masks all the times indoors and will teach children about wearing proper face covering. LPA reviewed Child Care Program Covid-19 Self Assessment with applicant during this inspection.

A small family child care license will be granted upon receipt of proof of corrections for the above. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license.

The applicant’s signature on this report acknowledges that they have signed the Application for a Family Child Care Home License (LIC 279) under the penalty of perjury that the statements on the application and any attachments are correct.

Exit interview was conducted with Applicant, Tamar A, Fazilian at 10:20 A.m.. Appeal rights explained & provided. A copy of this report and all other Licensing reports must be made available to the public for 3 years.
REPORT END 5 of 5

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2021

LIC809 (FAS) - (06/04)

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