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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191220762
Report Date: 01/24/2020
Date Signed: 01/28/2020 09:05:48 AM

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:YMCA OF METRO LOS ANGELES-CHANDLERFACILITY NUMBER:
191220762
ADMINISTRATOR:GOHAR ASLANYANFACILITY TYPE:
850
ADDRESS:14030 WEDDINGTONTELEPHONE:
(818) 906-1923
CITY:VAN NUYSSTATE: CAZIP CODE:
91401
CAPACITY:70CENSUS: 35DATE:
01/24/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Gohar AslanyanTIME COMPLETED:
03:14 PM
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Margarit Sislyan, Licensing Program Analyst (LPA), met with Gohar Aslanyan, Director and conducted a case management regarding an incident occurred at the facility on 11/14/19. The incident was reported to CCLD (Community Care Licensing Department) as required by Title 22 regulation.

According to the incident report a 6-year old child slipped and fell on the top of his left arm. The child dd not have a fracture.

LPA interviewed school staff. The child in question was not present

Preschool director stated that the child continues attending the school. He is doing well.

No complaint has resulted from this incident.

There are no violations.

No complaint has resulted from this incident.

Exit interview.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Margarit SislyanTELEPHONE: (424) 430-3049
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020
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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