198021226-8-16-2024-33-CC-AEIN-D87RN5-20240816130946

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198021226
Report Date: 08/16/2024
Date Signed: 08/16/2024 01:09:54 PM

Document Has Been Signed on 08/16/2024 01:09 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:	ANTONYAN FAMILY CHILD CARE		FACILITY NUMBER:	198021226
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 8	DATE:	08/16/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:00 AM
MET WITH:	Nune Antonyan, Licensee		TIME VISIT/ INSPECTION COMPLETED:	01:30 PM

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	ANNUAL INSPECTION WAS COMPLETED IN ARMENIAN Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced annual and case- management licensee- initiated inspection to the above facility on 08/16/24 due to licensee is requesting capacity increase. LPA arrived at the facility at 11:00 AM and met with licensee, Nune Antonyan who guided analyst on a tour of the facility. A COVID 19 risk assessment was conducted prior to entering the facility. LPA provided a copy of Entrance Checklist—Family Child Care Home (LIC126) to licensee, Nune Antonyan. Per licensee, she provides care to children 0-12 months old. Per licensee, facility operation hours are Monday to Friday 7:00 AM to 7:00 PM. Fire Clearance for Large Family Child Care Home was granted on 07/19/24. This is a one-story home located on the first level. The home consists of 3 bedrooms, 2 restrooms, living room, dining room, family room, kitchen, laundry room, front yard, and backyard (fenced). There are two ADUs in the back of the home with separated addresses, Unit A and Unit AA. Per licensee, parents enter the home through the main entrance door which leads to the living room and side gate which leads to the backyard. Per licensee the children use the bathroom in the Bathroom in the hallway, living room, dining room, kitchen, family room, one bedroom adjacent to the main entrance, and backyard (fenced). Per licensee areas off limits to children and parents include: Two bedrooms, one bathroom in the master bedroom, laundry room, and front yard. During this inspection individuals who reside in the home were discussed and notes on Confidential Name List (LIC811) and attached to this report. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. At 11:20 a.m., LPA was toured through the interior starting with the entry way REPORT CONTINUES ON NEXT PAGE 1 of 5

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024

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

FACILITY NAME: ANTONYAN FAMILY CHILD CARE	FACILITY NUMBER: 198021226
	VISIT DATE: 08/16/2024

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which leads directly to the living room and dining room (main daycare area). LPA observed 8 children were playing in the living room, two being school age children. The living room and dining room were inspected, and electrical outlets were observed to be covered. LPA observed children’s toys, chairs, tables and napping cots in the living room and dining room. There is a fireplace in the living room which has been blocked off by children cubbies to prevent access. Per licensee, cubbies are mounted to the ground. Next to the living room, the one bedroom adjacent to the main entrance was inspection and LPA did not observe hazards. LPA observed a bed in the bedroom. Next LPA toured the one daycare bathroom in the hallway and observed child safety latch was placed on the cabinet above the toilet where licensee stores cleaning compounds and personal belongings. Next LPA toured the two off-limit bedrooms and one off-limit bathroom in the master bedroom and did not observe hazards. LPA observed off-limit bedrooms door were closed and plastic door knob was on the door. Next LPA toured the kitchen and observed child proof safety latches on the cabinets where licensee stores sharp items and cleaning compounds. LPA observed a child safety sliding gate was installed to the kitchen to make the kitchen inaccessible to the children through dining room. Next LPA toured the family room and observed a TV and sofas in the family. Per licensee, children transpass from family room to go to the backyard. Next LPA toured the laundry room and did not observe any hazards. There is a door in the laundry room which leads to the drive way. Per licensee, she keeps the laundry room door closed during daycare hours. Per licensee, no poisons are kept in the home. LPA observed the required 2A 10BC fire extinguisher was anchored to the wall by the entrance door. It was serviced on 01/04/24 as read by LPA from the service tag. Licensee tested the carbon monoxide and smoke detectors in the hallway of bedrooms. It 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.

Next LPA toured the backyard fenced. Per licensee, children use the back yard for outdoor play time. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA observed a child safety gate was installed to the stairs in the balcony of family room which leads to the backyard. LPA did not observe any objects that can pose a danger to children on the outdoor yard. The applicant states that supervision is always provided. There is a door in the backyard which leads to the driveway.

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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024

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

FACILITY NAME: ANTONYAN FAMILY CHILD CARE	FACILITY NUMBER: 198021226
	VISIT DATE: 08/16/2024

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Per licensee, she provides food for children in care. Licensee was advised that if food is brought from the children’s homes, all containers must be labeled with child’s name and properly stored or refrigerated. Per Licensee, Nune Antonyan at 11:30 a.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 8 children were present in the home, two being school age. All adults present have obtained a criminal record clearance on Licensing Information System (LIS). Per licensee, currently she has one assistant. 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.

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 08/2024. Licensee, Nune Antonyan completed required mandated reporter training on 01/02/23. There are first aid supplies available on the premises in the hallway in a closet. LPA advised licensee that if a child shows signs of illness he/she/they shall be separated from other children.

At 12:20 p.m., facility roster was reviewed and completed. Per licensee currently there are 8 children enrolled. LPA reviewed 5 children's records, including emergency information from 8 enrolled children, and all 5 reviewed files were completed.

The licensee does/does not 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 08/15/24.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted at the wall by the entrance.

REPORT CONTINUES ON NEXT PAGE 3 of 5

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024

LIC809 (FAS) - (06/04)

Page: 3 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: ANTONYAN FAMILY CHILD CARE	FACILITY NUMBER: 198021226
	VISIT DATE: 08/16/2024

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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 5 reviewed files.

INFANT CARE: Licensee states that currently she has an infant 18 months old enrolled in her daycare. Licensee states that infants sleep in the daycare bedroom and daycare room where they are constantly supervised. 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 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-and-resources/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.

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.

REPORT CONTINUES ON NEXT PAGE 4 of 5

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024

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: ANTONYAN FAMILY CHILD CARE	FACILITY NUMBER: 198021226
	VISIT DATE: 08/16/2024

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

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today from the areas that were inspected today.

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 experience. If you have any questions regarding the process or tools, please send them by email 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/process.

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

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee, Nune Antonyan.

REPORT END 5 of 5

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024

LIC809 (FAS) - (06/04)

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