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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494156
Report Date: 06/09/2022
Date Signed: 06/09/2022 03:16:47 PM


Document Has Been Signed on 06/09/2022 03:16 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:DRMOYAN FAMILY CHILD CAREFACILITY NUMBER:
197494156
ADMINISTRATOR:DRMOYAN, ANNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 429-3793
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY:14CENSUS: 9DATE:
06/09/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Anna Drmoyan, LicenseeTIME COMPLETED:
03:35 PM
NARRATIVE
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On 06/09/2022, Licensing Program Analyst (LPA) Silva Garibyan conducted a Case Management- Deficiencies visit for the purpose of citing for the deficiencies that were observed during the investigation of Complaint CONTROL NUMBER 30-CC-20211207111550.
LPA met with Anna Drmoyan, Licensee and discussed the purpose of the visit. Licensee was present with 9 children (including three infants and 6 preschool age children).
Investigator Tiffany Brunelli during her visit along with the photos provided by the licensee observed the following deficiencies:

1) Infant Safe Sleep 102425 (b) Cribs or Play yards shall be free from all loose articles and objects : Child was observed sleeping his/her face covered with a blanket

2) Personal Rights: 102423 (a)(2) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. Child was observed sleeping in high-chair

3) Staffing Ratio and Capacity 102416.5: On 04/26/2022 the facility was out of ratio with three infants and four preschool age children with only assistant present. Licensee arrived within 15 minutes.

4) Operation of a Family Child Care Home 102417 (g)(10): Bouncer and Rocker was observed in the facility
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SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:
DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2022
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: DRMOYAN FAMILY CHILD CARE
FACILITY NUMBER: 197494156
VISIT DATE: 06/09/2022
NARRATIVE
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The facility was issued three Type A and one Type B citations in violation of Title 22 regulations. (See LIC 809-D for deficiency page).

An exit interview was conducted with Licensee Anna Drmoyan. A copy of this report, Notice of Site Visit, and Appeal Rights were provided to Licensee.

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SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 06/09/2022 03:16 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: DRMOYAN FAMILY CHILD CARE
FACILITY NUMBER: 197494156

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/09/2022
Section Cited

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Cribs or play yards shall be free from all loose articles and objects.
This requirement is not met as evidenced by:
Based on observations, Child was observed sleeping his/her face covered with a blanket which poses/posed an immediate health, safety risk to persons in care
Type A
06/09/2022
Section Cited

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The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.
This requirement is not met as evidenced by:
Based on observations, facility was out of ratio with three infants and four preschool age children with only assistant present.
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Which posed an immediate health and safety risk to persons in care
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Type A
06/09/2022
Section Cited

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safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement is not met as evidenced by: Chiold was observed sleeping in high-chair shich posed an immediate health and safety risk to persons in care
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: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:
DATE: 06/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4


Document Has Been Signed on 06/09/2022 03:16 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: DRMOYAN FAMILY CHILD CARE
FACILITY NUMBER: 197494156

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/23/2022
Section Cited

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A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Section 1596.846(b) and (c).
This requirement is not met as evidenced by:
Based on observations Bouncer and Rocker was observed in the facility which
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which poses/posed a potential health, safety or personal rights risk to persons 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: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:
DATE: 06/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4