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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494358
Report Date: 07/09/2021
Date Signed: 07/09/2021 12:37:30 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:MAMREYAN FAMILY CHILD CAREFACILITY NUMBER:
197494358
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 7DATE:
07/09/2021
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Zhanna Mamreyan/LicenseeTIME COMPLETED:
12:35 PM
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Required-1 Year Visit Conducted In Armenian
On 07/09/21 Licensing Program Analyst (LPA) Silva Garibyan, conducted an announced Required-1 Year and capacity increase inspections. LPA was met by Licensee, Zhanna Mamreyan. Also present was Staff #1. The fire department has granted the fire clearance for the capacity of 14 children. Fire Clearance granted on 7/08/21 by Inspector Willis, Burbank Fire Prevention Bureau. Days and hours of operation are 8:00 AM to 6:00 PM. LPA toured the home inside and outside and a census was taken. There were 7 children present (including 2 school age children and no infants) at the time of the visit. Current facility sketch was viewed and Licensee confirmed that the living/dining room, Playroom#1 on the right hand side, Playroom #2 on the left hand side, and the bathroom in Playroom#1 are used for providing care and are accessible to children. All other rooms and the detached garage/laundry room are off-limits and made inaccessible by use of safety knobs and child safety gates.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021
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: MAMREYAN FAMILY CHILD CARE
FACILITY NUMBER: 197494358
VISIT DATE: 07/09/2021
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There is a back house in the backyard which has different address ( 1030 ½ Parish Place, Burbank, 91506). The resident of this independent dwelling does not have access to the children in care. There is no swimming pool or other bodies of water on the premises. The front yard is on limits as children enter the home. The front yard is not used as a play area. The backyard is accessed through the dining room sliding glass doors and stairs leading to play area. There is green turf and one tree. The backyard has a 3 foot high linked child safety fence.
There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in this home. The home has working telephone service and LPA confirmed the phone number is (818) 445-3042. There are currently no infants enrolled in care.

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SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021
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: MAMREYAN FAMILY CHILD CARE
FACILITY NUMBER: 197494358
VISIT DATE: 07/09/2021
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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 in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

Licensee has a current roster of the children. There are 14 children enrolled in care. An emergency fire/disaster drill has been completed and documented within the last 6 months. Licensee's Mandated Reporter Training was completed on 07/22/19. Licensee's pediatric CPR/First Aid expires on 08/01/21. A review of records indicates that all employees and/or volunteers 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.

Incidental Medical Services (IMS) are not 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.

SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021
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: MAMREYAN FAMILY CHILD CARE
FACILITY NUMBER: 197494358
VISIT DATE: 07/09/2021
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 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.
The licensee is applying for an increase of capacity; Large Family Child Care Home license for a maximum capacity of 14. The licensee has an approved fire clearance ( Fire Clearance granted on 07/08/21 by LA Burbank Fire Prevention Bureau).

Capacity and Ratios: The licensee has applied for a capacity increase for a large family . The Maximum capacity is 12 with no more than 4 infants and a qualified assistant. Without a qualified assistant the license reverts back to the requirements for a small family childcare. Optional care may be provided for a maximum capacity of 14 children with no more then 3 infants, 2 school age children and a qualified assistant.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited. This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021
LIC809 (FAS) - (06/04)
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