Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015554
Report Date: 11/15/2017
Date Signed 11/15/2017 01:57:48 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:GHAZARYAN & AVETISYAN FAMILY CHILD CAREFACILITY NUMBER:
198015554
ADMINISTRATOR:RFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 333-6185
CITY:TUJUNGASTATE: CAZIP CODE:
91042
CAPACITY:14CENSUS: 8DATE:
11/15/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:57 PM
MET WITH:Nella Ghazayan TIME COMPLETED:
02:20 PM
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Licensing Program Analyst (LPA) Joanne Alcala conducted an annual random inspection at the above facility. Upon arrival LPA was greeted by licensee, Nella Ghazayan. LPA observed 8 day care children present. The licensee's assistant was also present. Per Licensing Information System (LIS) all adults residing and working in the home have obtained background clearances. Per LIS, facility annual fees are current. The licensee is operating within proper capacity and ratios. LPA observed licensee to be present at the home and providing adequate care and supervision.

The main care takes place in the garage in which has been converted into a permitted play room which also has a restroom for children to use. Children do not eat or sleep inside the home in the family room. The playroom is designed as a classroom. The play room and home are clean, orderly, comfortable and well ventilated. LPA observed a working smoke detector and Carbon Monoxide, fully charged 2A10BC fire extinguisher and working telephone. There are several age appropriate toys.

SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Joanne AlcalaTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2017
This report must be available at Child Care and Group Home facilities for public review for 3 years.
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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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: GHAZARYAN & AVETISYAN FAMILY CHILD CARE
FACILITY NUMBER: 198015554
VISIT DATE: 11/15/2017
NARRATIVE
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The children do not have access to the kitchen the licensee places a safety gate to block children from entering. Knives and medications are in accessible to children. The licensee stated that the restroom located near the entrance of the home is another restroom that is accessible to children. The restrooms were inspected for inaccessibility of toxins/cleaning compounds and other potentially dangerous objects/materials. Electrical outlets around the home were properly covered. Per the licensee, there are no firearms on the premises. The licensee has current CPR and first aid that expires 12/1/18.

The back yard was clean and toys were age appropriate and in a good repair. The yard has a gazebo and a porch that provides shade. The backyard is completely fenced in. There are no bodies of water in the FCCH.

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

SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Joanne AlcalaTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2017
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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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: GHAZARYAN & AVETISYAN FAMILY CHILD CARE
FACILITY NUMBER: 198015554
VISIT DATE: 11/15/2017
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The facility was not in compliance per Title 22 regulations, a Type B deficiency will be cited today 11/15/2017. An exit Interview was conducted, a copy of this Report and a Notice of Site visit was provided and appeal rights were discussed.
SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Joanne AlcalaTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2017
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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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: GHAZARYAN & AVETISYAN FAMILY CHILD CARE
FACILITY NUMBER: 198015554
VISIT DATE: 11/15/2017
NARRATIVE
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The licensee and her assistant could not provide proof of the required immunization's. This will be a citation.

LPA observed a current child roster. Per the licensee, fire and disaster drills are conducted monthly. Child files were found to be complete.

Licensee has the required documents posted in the FCCH; Facility License (LIC 203), Emergency Disaster Plan (LIC610a), Notification of Parents' Rights Poster (PUB 394).

The following was discussed with the licensee;


No smoking, No infant walkers, Johnny jumpers, exersaucers and any other item that falls into that category, earthquake safety and necessity of drills (every 6 months), required forms for children’s files, facility files, posting requirements, penalty, fingerprint clearance, and the transfer process and penalty.
For additional information and forms visit our website at: www.ccld.ca.gov
A copy of this report must be made available to the public for 3 years.

For updates on Community Care Licensing please visit the following website at: Childcareadvocatesprogram@dss.ca.gov
https://ccld.childcarevideos.org/
SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Joanne AlcalaTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2017
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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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: GHAZARYAN & AVETISYAN FAMILY CHILD CARE
FACILITY NUMBER: 198015554
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/13/2017
Section Cited
HSC
1597.622a1
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Employees or volunteers at family day care home; immunization requirements; records; exemptions:Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis,
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The licensee and her assistant agree to get vaccinated or get proof that they have already had the required immunization's and submit proof to CCL by plan of correction date 12/13/17.
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and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. The licensee and her assistant did not have proof of the required immunization's.
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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: Adriana HernandezTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Joanne AlcalaTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2017
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2017
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