197419778-6-16-2022-30-CC-LRIS-CFMSBH-20220622134357

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197419778
Report Date: 06/16/2022
Date Signed: 06/16/2022 10:32:46 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/28/2022 and conducted by Evaluator Antonio Almanza

PUBLIC

COMPLAINT CONTROL NUMBER: 30-CC-20220328124629

FACILITY NAME:	AGSHEHIRLYAN FAMILY CHILD CARE		FACILITY NUMBER:	197419778
ADMINISTRATOR:	KARINE AGSHEHIRLYAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 448-6767
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91601
CAPACITY:	14	CENSUS: 13	DATE:	06/16/2022
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Licensee KARINE AGSHEHIRLYAN		TIME COMPLETED:	10:35 AM

ALLEGATION(S):

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Allegation: Day care child sustained unexplained injury while in care.

INVESTIGATION FINDINGS:

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On 06/16/2022 at 9:35 a.m., Antonio Almanza, Licensing Program Analyst (LPA), conducted an unannounced site visit for the purpose of delivering finding for complaint received on 03/28/2022. LPA met with KARINE AGSHEHIRLYAN, Licensee, and explained the purpose of the visit. During today’s visit there are 3 adults and 13 children in care.

During the course of the investigation, LPA Antonio Almanza conducted interviews and reviewed records regarding Allegation, Day care child sustained unexplained injury while in care.
According to the parent, when the infant child was picked up from the facility, the child’s face was red from crying and full of sweat. During pick up the child’s parent was notified that the child was crying because of an upset stomach and hard stool. The facility is reporting that the child had a stomachache and started crying during diaper change around 3:00 p.m. or 3:30 p.m.

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Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Antonio Almanza	TELEPHONE: (424) 301-3049
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 30-CC-20220328124629

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: AGSHEHIRLYAN FAMILY CHILD CARE	FACILITY NUMBER: 197419778
	VISIT DATE: 06/16/2022

NARRATIVE

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The Licensee was not present at the facility when the child was picked up. Facility staff are reporting that the child did not have any marks during pick up and that the child did not sustain any injuries while in care.

The child’s parent called the facility right after picking up the child to inquire about the red markings on the child’s face. The facility notified the child’s parent that the facility did not know how the child received the red marks on the face.

LPA received images of the childs face where it is clearly visible that the child has red markings on the left cheek from mouth to ear. There are two red lines that come from the child’s ear and meat near the child’s mouth. There are small dotes in the child’s ear that are dark like bruises, that are within the lines of the red marks. The child has light complexion and the red marks are clearly visible. The child was taken to the hospital for the red marks on the face and the child was seen by a Doctor for “facial contusion, but no other injuries or suspicion of injury, all else appeared normal.”

After considering all available information, the child had unexplained red markings to the left side of the cheek and dark bruise like dots in the left ear; and the facility is not able to explain what happened to the child. Based on interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

One Type B citation is being issued under California code of Regulations, Title 22, Division 12 & Chapter 1, are being cited on the attached LIC9099D.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation. Failure to maintain posting as required will result in a civil penalty of $100.00.
A copy of this Report (LIC9099 & LIC9099D), Appeal Rights, and Notice of Site Visit were reviewed and provided to the Licensee KARINE AGSHEHIRLYAN.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Antonio Almanza	TELEPHONE: (424) 301-3049
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 30-CC-20220328124629

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: AGSHEHIRLYAN FAMILY CHILD CARE	FACILITY NUMBER: 197419778
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/16/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/24/2022 Section Cited CCR 102423(a)(2)	1 2 3 4 5 6 7	102423 Personal Right (a) Each child receiving services from a family child care home shall have certain rights… (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This Requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee will provide LPA written statement acknowledging that children will be assess for possible injuries if they are cryin durig the day and inform parents of any possible ailments they may have.
	8 9 10 11 12 13 14	Based on interview and record review, child in care sustatnined an unexplained injury, which poses an potential Health or Safety, or personal rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Antonio Almanza	TELEPHONE: (424) 301-3049
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022

LIC9099 (FAS) - (06/04)

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