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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624118
Report Date: 12/02/2021
Date Signed: 12/02/2021 03:33:48 PM

Document Has Been Signed on 12/02/2021 03:33 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:MOVSISYAN, HASMIKFACILITY NUMBER:
343624118
ADMINISTRATOR:MOVSISYAN, HASMIKFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 600-0080
CITY:SACRAMENTOSTATE: CAZIP CODE:
95827
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
12/02/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Hasmik MovsisyanTIME COMPLETED:
03:50 PM
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At 2:20 p.m. on Thursday, December 2nd, 2021, Licensing Program Analyst (LPA) Karyn Guerra met with Applicant, Hasmik Movsisyan, for the purpose of a prelicensing, change of location inspection. Applicant was previously licensed at facility #343619499. All individuals subject to criminal background review have obtained a criminal record clearance. Applicant has obtained an approved fire clearance for the large family child care home.

The single story home consists of 3 bedrooms, 2 bathroom, kitchen, living room and dining room. Off limits area will consist of the Garage. Applicant acknowledges that children must never enter the off-limits area. Hours of operation are 6:00 a.m.-6:30p.m, Monday thru Friday. Applicant understands they must live in the home and be present at the facility for 80% of operating hours. Applicant's spouse owns the home and provided proof of control of property via mortgage statement.

Applicant guided LPA on a tour of the home, and a health and safety inspection was conducted. LPA observed the required postings. LPA observed functioning smoke and carbon monoxide detectors, and a fire extinguisher. Fireplace is barricaded to prevent access by children. Toxic and hazardous items were appropriately stored, inaccessible to children. Applicant stated that there are no firearms nor poisons in the home.

The backyard space is fenced. Applicant understands that 100% supervision is required around bodies of water and in unfenced areas. LPA did not observe any bodies of water on the premises.

LPA reviewed infant safe sleep regulations with Applicant. Applicant understands there shall be a crib or play yard for each infant who cannot climb out of a crib or play yard. Applicant understands an individual infant sleeping plan LIC9227 shall be on file for each infant up to 12 months old.

Report continued on 809-C.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE: DATE: 12/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2021
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: MOVSISYAN, HASMIK
FACILITY NUMBER: 343624118
VISIT DATE: 12/02/2021
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Applicant has completed the required Preventative Health and Safety course which includes 1 hour of nutrition. Applicant is enrolled in the one hour lead prevention training course and will follow up with LPA when completed. Applicant has current EMSA certified CPR and First Aid certification, expiring 06/2023. AB1207 Mandated Reporter training is current, expiring 12/2021.

LPA reviewed COVID-19 industry guidance with Licensee.

Licensee was encouraged to visit the Department’s website at www.cdss.ca.gov for more information regarding child care updates, forms, regulations and legislation. An exit interview was conducted.

As of today, Thursday, 12/2/2021, the change of location is approved for the licensee to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child is in kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of 2 years. When there is no assistant present, then it will revert back to the small capacity.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021
LIC809 (FAS) - (06/04)
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