198021256-6-19-2023-33-CC-AEIN-CSXPME-20230619112614

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198021256
Report Date: 06/19/2023
Date Signed: 06/19/2023 11:26:24 AM

Document Has Been Signed on 06/19/2023 11:26 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:	AZIZYAN AND HAKOBYAN FCC		FACILITY NUMBER:	198021256
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	06/19/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Marine Azizyan and Narek Hakobyan, Applicants		TIME COMPLETED:	11:45 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 06/19/2023. LPA arrived at the facility at 8:30 AM and met with Marine Azizyan and Narek Hakobyan, Applicants who guided analyst on a tour of the facility. Pre-licensing Entrance Checklist (LIC9280) was provided to applicants, Marine Azizyan and Narek Hakobyan, Applicants. During this inspection individuals who reside in the home were discussed and notes on Confidential Name List (LIC811) and attached to this report. A COVID 19 risk assessment was conducted prior to entering the facility. Per applicant operation hours will be Monday to Saturday, 7:00 a.m. to 10:00 p.m.. Applicants state they will care for children 0-14 years old. Applicants previously were licensed at 510 South Belmont Street, Unit C, Glendale, CA 91205 with facility number 198021156. All areas identified on the facility sketch were inspected. This is a one story home located on the first level. The home consists of 3 bedrooms, 1 & 1/2 restrooms, living room, dining room, kitchen, balcony, laundry room, front yard, backyard (fenced), detached back house which consists of a bathroom, living room, kitchen, and a bedroom. There is a fireplace in the living room which has been blocked off to prevent access to children. Per applicants, parent will enter the home through the main entrance door which leads to the living room. There is a in ground pool on the premises which is located in the backyard. Pool is inaccessible and surrounded with cement walls in two sides, and five feet high fences, with less than 4 inches opening in two sides. Also gates swing away from the pool, self-closed and have a self-latching device located no more than six inches from the top of the gate. The fence meets Title 22 Regulations. Per applicants pool area is off-limit and inaccessible to the children. (Pictures were taken). REPORT CONTINUES ON NEXT PAGE 1 of 6

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2023

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: AZIZYAN AND HAKOBYAN FCC	FACILITY NUMBER: 198021256
	VISIT DATE: 06/19/2023

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Areas that are accessible to children are as follows: Bathroom in the hallway, living room, dining room, kitchen, two bedrooms, laundry room, balcony adjacent to the dining room, and side yard (fenced).

Areas off limits based on facility sketch submitted to children and parents include: One bedroom, half bathroom, back balcony adjacent to the laundry room, pool area in the backyard, front yard, and entire detached guests house which consists of a bedroom, one bathroom, living room, kitchen.
**Rooms that are off-limits need to be made inaccessible during operating hours**

The applicants do understand that licensing staff may have access to off-limit areas during inspection if necessary.

At 9:00 am, the applicants began touring LPA’s through the home starting with the entry way which lead directly to the living room. The living room was inspected and electrical outlets were observed to be covered. LPA observed a sofa, children tables, and chairs in the living room. LPA observed a chain lock on the main entrance door, located six feet high. LPA observed fireplace in the living room was blocked off to prevent access. Next to the living room, the dining room was inspected and LPA observed a dining table and chairs in the dining room. Next LPA toured the balcony adjacent to the dining room and observed a foldable table and four chairs in the balcony. Next LPA toured the one off-limit bedroom and did not observe any hazards. Next LPA toured the two daycare bedrooms and did not observe any hazards. LPA observed children toys and napping cots in the two bedrooms. Next LPA toured the one bathroom in the hallway and observed child proof safety latches on the cabinets under the sink and on the shower door. Next LPA toured the off-limit half bathroom inside the bedroom and did not observe any hazards. Next LPA toured the kitchen and observed child proof safety latches on the cabinets where applicants store sharp items and cleaning compounds. Next LPA toured the laundry room and did not observe any hazards. Per applicants, children will walk through the kitchen and laundry room to go to the side yard. LPA observed the required 2A 10BC fire extinguisher was placed on the cabinet in the kitchen. It was purchased on 01/05/23 as read by LPA from the receipt. Applicants tested the carbon monoxide and smoke detectors in the bedroom room. 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.

REPORT CONTINUES ON NEXT PAGE 2 of 6

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2023

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: AZIZYAN AND HAKOBYAN FCC	FACILITY NUMBER: 198021256
	VISIT DATE: 06/19/2023

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Next LPA toured the backyard fenced. Per applicants pool area in the backyard and detached guests house are off-limit. Per applicants, pool gate will be kept closed all the times during outdoor playtime. Per applicants, back balcony which is adjacent to the laundry room is off-limit and children will only transpass to go to the side yard. Per applicants, children will use the side yard (fenced) for outdoor activity. 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 did not observe any objects that can pose a danger to children on the outdoor yard. The applicants state that supervision is always provided. LPA asked applicants to add a child safety gate in the back balcony to make the back balcony inaccessible to the children.

The applicants state that they will provide food for children in care. Applicants were 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 applicants, at 10:20 am, there are no pets, weapons, firearms or bodies of water on the premises. There are toys available for children. There is telephone service via a cellphone that is used and the cellphone stays at the facility during operation hours. LPA advised applicant that if a child shows signs of illness he/she/they shall be separated from other children. Per applicant no one smokes in the home. There are first aid kit in the home, in the kitchen.

Applicants have proof of CPR and First Aid training as indicated on the certificate. The applicants have proof of Health and Safety training (Narek Hakobyan completion date: 11/24/22 and Marine Azizyan: 11/22/22), Pediatric First Aid and CPR (Narek Hakobyan: ex. 11/24 and Marine Azizyan: ex. 10/24). The applicants have proof of immunization against influenza, pertussis, and measles.
Applicants completed required mandated reporter training, Narek Hakobyan: 11/06/22 and Marine Azizyan: 11/03/22. Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com

The following was discussed with the applicant:
Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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 3 of 6

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2023

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: AZIZYAN AND HAKOBYAN FCC	FACILITY NUMBER: 198021256
	VISIT DATE: 06/19/2023

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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.

SAFE SLEEP: LPA discussed the safe sleep regulations with applicant 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 applicant 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.
REPORT CONTINUES ON NEXT PAGE 4 of 6

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2023

LIC809 (FAS) - (06/04)

Page: 4 of 6

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: AZIZYAN AND HAKOBYAN FCC	FACILITY NUMBER: 198021256
	VISIT DATE: 06/19/2023

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INFANT CARE: Applicants state that they will care for infants. Applicants state that infants will sleep in the daycare bedrooms where 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 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 informed Applicants infants can not be swaddled while in care. LPA advised the Applicants 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 Applicants 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.

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

Per applicants, there are no dual licenses at this address. Applicants' email address was obtained during this inspection. The applicants were advised that email may be public information.

Per applicants, they do 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.

REPORT CONTINUES ON NEXT PAGE 5 of 6

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2023

LIC809 (FAS) - (06/04)

Page: 6 of 6

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: AZIZYAN AND HAKOBYAN FCC	FACILITY NUMBER: 198021256
	VISIT DATE: 06/19/2023

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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

The following corrections need to be corrected prior to obtaining a small family child care license. Corrections are due by 06/30/23:

1. Applicants will add a child safety gate in the back balcony to the make the balcony inaccessible to the children.
2. Applicants will add a door alarm to the laundry area door which leads to the backyard.

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

The applicants' 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 conducted and report was reviewed with the applicants, Narek Hakobyan and Marine Azizyan at 11:45 AM..

REPORT END 6 of 6

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2023

LIC809 (FAS) - (06/04)

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