197494922-9-28-2021-30-CC-AALA-C7AP6K-20210928110229

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494922
Report Date: 09/28/2021
Date Signed: 09/28/2021 11:02:42 AM

Document Has Been Signed on 09/28/2021 11:02 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	PETROSYAN FAMILY CHILD CARE		FACILITY NUMBER:	197494922
ADMINISTRATOR:	MELINE PETROSYAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 645-0199
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91343
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	09/28/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:49 AM
MET WITH:	Meline Petrosyan		TIME COMPLETED:	11:12 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	On 09/28/2021 at 8:39 am, Licensing Program Analyst (LPA) Antonio Almanza conducted an announced Change of Location Prelicesning Inspection and met with the applicant Meline Petrosyan who guided LPA on a tour of the home inside and out located at 16746 BAHAMA STREET, NORTHRIDGE CA 91343. The applicant is applying for a Large Family Child Care License to operate Monday through Saturday from 7:00 am to 7:00 pm and serve children ages 1 year to 12 years of age. The single-story home is a 1 bedroom, 1 bathroom home located behind 16748 Bahama St Northridge Ca 91343. The home will be entered by parents on the left side of the property through a walk way past 2 gates on the left side of the front property. The gates will be kept unlocked during pick up and drop off. The applicant states the main care will be provided in the Living room, children will use the bathroom and the bedroom will be used for children to sleep in. The off-limits areas of the home are as follows: Kitchen and laundry room. Applicant will provide meals and snacks to children in care. Applicant will use a cell phone for the family child care home and was advised that the cell phone should remain in the home while children are in care. LPA observed age appropriate toys, 7 cots and 1 playpen. LPA did not observe any hazards for children. There is a fully equipped 2A10BC fire extinguisher located in the kitchen closet. The applicant places all sharp items/knifes and medication in top kitchen cabinet. LPA observed required postings. LPA observed an operating Smoke/ CO detector in living room. Cleaning supplies are kept under the kitchen sink. Applicant stated there are no weapons or firearms in the home and LPA did not observe any. The yard is located in front of the home located between the two properties and will be used by children in care. The yard has white panel fencing that is at least 5 feet tall with a gate between the two properties that is kept locked by the applicant. There is concrete slab on the floor for children to play on. There are is no shade in the yard for children to play in.

SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: PETROSYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494922
	VISIT DATE: 09/28/2021

NARRATIVE

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The following was discussed with the applicant:
-Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. If the aforementioned is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately. Please advise your analyst of any person who will be visiting regularly or for longer than one week. -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.
-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, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. The family day care home shall maintain documentation of the required immunization's or exemptions from immunization, as set forth in this section, in the person’s personnel record that is maintained by the family day care home. -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. Smoke and carbon monoxide detectors should be checked, and batteries should be replaced. -Changes should be reported the to the Department as soon as they occur such as construction and remodeling. -Telephone number changes and/or if you move from home. -Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. -Fire and safety drills must be performed every six months and documented for review by the Department. -The smoking of tobacco in a private residence that is licensed as a family child care home shall be prohibited and in those areas of the family day care home where children are present.
- Children and Staff records must be maintained and updated as needed and must be available for review by the Department. -Saucer chairs, bouncers, walkers, or any similar items are prohibited. -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. -LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.
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SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: PETROSYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494922
	VISIT DATE: 09/28/2021

NARRATIVE

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The applicant was informed of the Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541
Email: [email protected]

AB 1207: Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com

Safe Sleep Links:
AAP:https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials, PIN 20-24-CCP: Recently Approved Safe Sleep Regulations In Effect. PIN 20-24-CCP: Recently Approved Safe Sleep Regulations In Effect

Incidental Medical Services: 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 Incidental Medical Services Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering EpiPen Jr. and EpiPen or other Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Emptying an Ileostomy Bag.

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SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: PETROSYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494922
	VISIT DATE: 09/28/2021

NARRATIVE

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The applicant was advised that, once licensed, the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, (Type A violation), a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. The applicant was made aware that a licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment.

The following is needed prior to approval for licensure.

1. First aid kit.
2. Latch on laundry room door.
3. Child safety gate in kitchen entrance.
4. Latch on kitchen cabinet under sink where cleaning and disinfecting solutions are kept.
5. Drain cover in yard installed.
6. Update facility Sketch
7. LPA to verify that all required documents are on file.
8. Licensure approval by Licensing Program Manager.

An Exit Interview was conducted, and a copy of this report was provided to the applicant Meline Petrosyan. It has been explained that a reply to the email shall be considered a substitute for the hard-copy signature.

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SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021

LIC809 (FAS) - (06/04)

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