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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494077
Report Date: 08/30/2024
Date Signed: 08/30/2024 01:21:28 PM


Document Has Been Signed on 08/30/2024 01:21 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:ARUTYUNYAN FAMILY CHILD CAREFACILITY NUMBER:
197494077
ADMINISTRATOR:ARUTYUNYAN, MARINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 281-4895
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY:14CENSUS: 6DATE:
08/30/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:58 AM
MET WITH:MARINA ARUTYUNYANTIME COMPLETED:
01:20 PM
NARRATIVE
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On 8/30/2024, Licensing Program Analyst(LPA) Suzette Ornelas conducted an unannounced case management inspection for the purpose of deficiencies observed during a complaint investigation for complaint control #58-CC-20240626121252. Upon arrival LPA was greeted by licensee, MARINA ARUTYUNYAN and observed 6 children and 1 adults.

LPA Ornelas investigated complaint control #58-CC-20240626121252. According to the complaint investigation report received on 6/26/2024, Licensee did not report an unusual incident that occurred at the facility resulting in a child sustaining an injury on 5/31/2024.

Based on interview conducted with licensee, licensee stated that a child was injured at the facility; however, she did not report it to the department. It was confirmed that the incident was not reported to the Department within 24 hours. No direct contact with the on duty worker or the analyst was made within 24 hours.

LPA explained to the licensee that when an incident occurs, according to Title 22 Regulations, the incident must be reported to the department within 24 hrs., and a written report using the unusual incident /injury report LIC624 form must be filled out and mailed or emailed to the department within 7 days. Licensee understands and will comply.

The following Type B deficiency is being cited on 8/30/2024 in accordance to Title 22 of the California Code of Regulations: 102416.2 Reporting Requirements. (b)The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home. (3) Health and Safety Code Section 1597.467(b)(1) provides in part: "A report shall be made to the Department…following the occurrence during the operation of a family day care home of any of the following events: (A) Death of any child from any cause. (B) Any injury to any child that requires medical treatment.
SUPERVISOR'S NAME: Raul NavarroTELEPHONE: (424) -30-3072
LICENSING EVALUATOR NAME: Suzette OrnelasTELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2024
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ARUTYUNYAN FAMILY CHILD CARE
FACILITY NUMBER: 197494077
VISIT DATE: 08/30/2024
NARRATIVE
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 Please refer to 809D for cited deficiencies.

A copy of this report, notice of site visit, and appeal rights were provided. 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 licensee.
SUPERVISOR'S NAME: Raul NavarroTELEPHONE: (424) -30-3072
LICENSING EVALUATOR NAME: Suzette OrnelasTELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 08/30/2024 01:21 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: ARUTYUNYAN FAMILY CHILD CARE
FACILITY NUMBER: 197494077

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/13/2024
Section Cited
CCR
102416.2(b)(3)(B)

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102416.2(b)(3)(B) Reporting Requirements - (b)The licensee shall report to the Department any of the events as specified in Health and Safety Code...that occur during the operation of the family child care home.. (B) Any injury to any child that requires medical treatment. This requirement is not met as evidence by:
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Licensee agrees to watch the child care reporting requirements video at the follwoing website:
ccld.childcarevideos.org
and submit a summary of what the reporting requirememnts are along with a completed LIC624. (unusual incident form)
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Based on interviews conducted, Licensee did not ensure the child injury that required medical attention was reported to the department. This poses a potential risk to 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: Raul NavarroTELEPHONE: (424) -30-3072
LICENSING EVALUATOR NAME: Suzette OrnelasTELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2024
LIC809 (FAS) - (06/04)
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