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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191224574
Report Date: 09/08/2021
Date Signed: 09/08/2021 12:13:42 PM

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:DEMIRJIAN FAMILY CHILD CAREFACILITY NUMBER:
191224574
ADMINISTRATOR:DEMIRJIAN, SELVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 923-5388
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:14CENSUS: 9DATE:
09/08/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:DEMIRJIAN SELVATIME COMPLETED:
12:20 PM
NARRATIVE
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On 9/8/2021 at 9:50 AM, Licensing Program Analyst (LPA) Loyce Phillips, conducted an unannounced Annual Required Inspection and was met by Licensee, Demirjian Selva. Licensee operates Monday through Friday 8:00AM to 5:00PM.

LPA toured the home inside and outside and a census was taken. LPA observed 9 children in care. Current facility sketch reviewed and Licensee confirmed that the entire main house is off limits to children and made in accessible by door locks. Children are not allowed inside the main house. Children have access to child care area located towards the back of the home, with an entry gate and door to the left of the home. The outdoor play area is located in the backyard with age appropriate toys and equipment.

There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. All poisons, detergents, cleaning compounds, medication and other hazardous items are kept in the main house and made inaccessible to children by a door lock from the inside. No poisons were observed during the inspection.

There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs located in the home. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (818) 923-5388.

SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
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: DEMIRJIAN FAMILY CHILD CARE
FACILITY NUMBER: 191224574
VISIT DATE: 09/08/2021
NARRATIVE
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Licensee stated she is currently caring for infants. LPA discussed Safe Sleep Regulations with licensee. Which includes each infant in care should have their own crib or play yard. The cribs and play yards should be kept free from all loose articles and objects while infants are sleeping; and there should be no objects hanging above or attached to the crib or play yard. Infants should not be swaddle while in care. Licensee will physically check on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants should be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is completed and placed in the file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area is in the front yard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter Training was completed on 7/21/2020 Licensee’s pediatric CPR/First Aid expired on 4/20/2023. A review of records indicates that Licensee have immunization records on file for influenza, pertussis and measles.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Licensee stated there are no additional adults that live in the home.

SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: DEMIRJIAN FAMILY CHILD CARE
FACILITY NUMBER: 191224574
VISIT DATE: 09/08/2021
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Incidental Medical Services (IMS) are currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: (see next page, 809 D) Licensee was provided a copy of their appeal rights.

An exit interview was conducted, a copy of this report was read and provided to the Licensee, Selva Demirjian. The report shall be made available to the public upon request. LIC 9213 Notice of Site Visit was provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: DEMIRJIAN FAMILY CHILD CARE
FACILITY NUMBER: 191224574
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/20/2021
Section Cited

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102425(j)(1)(2)(D)Infant Safe Sleep The provider shall supervise infants while they are sleeping and adhere to the following requirements:(1) The provider shall physically check on the infant every 15 minutes. (2)The provider shall check and document the following:(D)Documentation shall be maintained in the infant’s file....
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This requirement was not met as evidenced by: based on file review, licensee failed to provide documentation regarding safe sleep. If not corrected, this poses a potential risk to the children in care.
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Type B
09/20/2021
Section Cited

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102425(c)(1) An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 month of age the provider has in care and maintained at the facility in the infant’s file. (1) This plan shall be signed and dated by the infant's authorized representative.
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This requirement was not met as evidenced by: based on file review and interview with licensee. Infant's file was missing LIC 9227. If not corrected, this poses a potential risk to the children in care.
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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: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:
DATE: 09/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4