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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493963
Report Date: 06/20/2019
Date Signed: 06/20/2019 11:53:51 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:KIDSVERSITYFACILITY NUMBER:
197493963
ADMINISTRATOR:INDZHYAN,A.&KHACHATRYAN,M.FACILITY TYPE:
850
ADDRESS:310 E ALAMEDA AVETELEPHONE:
(818) 476-2639
CITY:BURBANKSTATE: CAZIP CODE:
91502
CAPACITY:44CENSUS: DATE:
06/20/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Mariam Khachatryan, OwnerTIME COMPLETED:
10:21 AM
NARRATIVE
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Licensing Program Analyst (LPA), Shandra Powell conducted a Case management deficiencies visit during a Complaint investigation. Upon arrival LPA was greeted by Arshaluys Indzhyan, Director . During the walk through of the facility LPA observed the following:

1. LPA observed two school age children ages 8 and 9 in classroom with preschoolers. The school age children were interacting with preschool children. The children are the children of the Licensee's. The Licensee is licensed to serve children ages 2yrs. old through entry into 1st grade. Therefore the Licensee is operating beyond the terms and condition of their license and are not incompliance. This poses an immediate risk to the health and safety of children in care.

LPA advised how to access forms and regulations on line at www.ccld.ca.gov for updates on current regulatory changes.

The following are being cited in accordance to Title 22 of the California Code of Regulations. Please refer to 809D for cited deficiencies.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon their return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled child for the next 12 months. A signed Acknowledgement of Receipt (LIC9224) shall be in each child’s file, acknowledging receipt.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Director, /including, but not limited to Provider Rights, Appeal Procedures

SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
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: KIDSVERSITY
FACILITY NUMBER: 197493963
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/20/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/20/2019
Section Cited
CCR
101161(a)
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Limitations on Capacity- A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation. The requirement is not met as evidenced by LPA observing two School Age Children interacting with preschool children at facility.
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Director will send school age children home. Director stated school age children will not be present at facility anymore.
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This poses an immediate risk to the health and safety of 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: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
LIC809 (FAS) - (06/04)
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