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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618378
Report Date: 02/15/2022
Date Signed: 02/15/2022 12:51:56 PM

Document Has Been Signed on 02/15/2022 12:51 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:GASPARYAN, SVETLANAFACILITY NUMBER:
343618378
ADMINISTRATOR:GASPARYAN, SVETLANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 859-9979
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
02/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Svetlana GasparyanTIME COMPLETED:
01:05 PM
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On 2/15/22 at 11:20AM, a required annual inspection was made to the facility by Licensing Program Analyst (LPA), Mikah Martinez. A review of staff records on 2/8/22 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are currently 5 adults living in the home. At 12:00 the home was toured inside and outside. The licensee and her assistant were supervising 12 children, and operating within the licensed capacity and ratio requirements. The facility’s operating hours are 6:30AM-6PM, Monday–Friday. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are the three bedrooms and garage, LPA Martinez advised that the doors of the bedroom should have child lock. Poisons are locked in the laundry room. Items which could pose a danger to children (detergents, cleaning compounds, medications, etc.) are stored out of the reach of children. There is a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The licensee stated there are no firearms and/or other dangerous weapons in the home, and none were observed during today's inspection. The home is clean, orderly and comfortable. There are safe toys and equipment available for children. There is a working telephone in the home.
There are cribs/play yards available for napping infants. Cribs have firm mattresses and are free of loose objects. Bedding is laundered weekly, and soiled bedding is stored inaccessible to infants. Napping infants are checked on every 15 minutes, however LPA observed no infant safe sleep documentation in the files and checks are not logged during nap times.
SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Mikah Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2022
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: GASPARYAN, SVETLANA
FACILITY NUMBER: 343618378
VISIT DATE: 02/15/2022
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The children use the back yard as the outdoor play area and it is fully fenced. There were no pools or other bodies of water observed in the yard

Twelve children's records were reviewed at 11:30AM; required emergency information forms were observed to be on file. Individual Sleeping Plans were not on file for infants under 12 months of age. The licensee has completed Mandated Reporter training. The licensee and all employees have the required immunizations on file. The licensee has current pediatric CPR and First Aid certification, which expire on 8/2022.

This report was reviewed and discussed with the licensee. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.
SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Mikah Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/15/2022 12:51 PM - It Cannot Be Edited


Created By: Mikah Martinez On 02/15/2022 at 12:33 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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: GASPARYAN, SVETLANA
FACILITY NUMBER: 343618378

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above in 4 out of 4 of the infant files where they were missing infant safe sleep plans which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/04/2022
Plan of Correction
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Licensee plans to submit copies of Infant safe sleep plans for the infants in care no later than 3/4/22.
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:Maria Mayorga
LICENSING EVALUATOR NAME:Mikah Martinez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2022


LIC809 (FAS) - (06/04)
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