197494806-11-18-2021-30-CC-LSTN-C8VRN5-20211118120946

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494806
Report Date: 11/18/2021
Date Signed: 11/18/2021 12:10:03 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:	SARKISYAN FAMILY CHILD CARE		FACILITY NUMBER:	197494806
ADMINISTRATOR:	VERA SARKISYAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 582-8888
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91405
CAPACITY:	14	CENSUS: 11	DATE:	11/18/2021
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	09:18 AM
MET WITH:	Vera Sarkisyan		TIME COMPLETED:	12:24 PM

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On 11/18/2021 Licensing Program Analyst (LPA) Laticia Thompson conducted an unannounced case management visit for the purpose of inspecting bodies of water (swimming pool). Upon arrival to the facility LPA met with Vera Sarkisyan (licensee). LPA observed 2 adults, Licensee, Anahit Tovmasyan (assistant) and 7 children.

LPA inspected the swimming pool located in the backyard area of the home behind the play yard equipment. LPA observed the pool is enclosed and surrounded by a solid white vinyl fence panel that measures at 6 feet in height. The bottom of the fence is on a hard concrete surface that measures less than four inches. The fence gate swings away from the body of water, is self-closing, self-latching and located no more than 6 inches from the top of the gate and 54inches off of the ground. The back French doors that lead into the backyard area triggers a chime sound. Licensee stated she is in the process of installing an alarm on the doors within the next 2 weeks.

The fencing obscure’s the view of the body of water from the facility therefore the swimming pool does not meet compliance of Title 22 102417.

A plan of correction will be discussed with Management and provided to licensee on a later date.

During today's visit LPA observed licensee caring for 11 children without an assistant. Licensee stated assistant had to run to Rite Aid and will be returning within a minute.

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Laticia S Thompson	TELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021

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: SARKISYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494806
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/18/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/18/2021 Section Cited	1 2 3 4 5 6 7	102416.5(e) Staffing Ratio and Capacity If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). This requirement was not met as evidence by
	8 9 10 11 12 13 14	based on LPA's observation of 11 children under the care of licensee only, this poses an immediate Health & Safety risk to children in care.	8 9 10 11 12 13 14
	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: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Laticia S Thompson	TELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021

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: SARKISYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494806
	VISIT DATE: 11/18/2021

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LPA advised licensee she can not care for more than 6-8 children without an assistant. Assistant arrived back at the facility with an additional child upon her arrival bringing the census to a total of 12 children under school age. Licensee is cited a Type A violation (see LIC 809D).

An exit interview was conducted with licensee, in which this report was read to her. The Licensee was advised that the Notice of Site Visit (LIC 9213) and a copy of this report must be posted at the entrance of the facility for a period of 30 days. Failure to post required visit reports for 30 consecutive days will result in immediate civil penalty assessment of $100.

Licensee shall provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. The licensee shall require each recipient of the licensing report described pertaining to type a violation to sign a statement indicating that he or she has received the document and the date it was received on the Acknowledgment of Receipt of Licensing Reports (LIC 9224).

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Laticia S Thompson	TELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021

LIC809 (FAS) - (06/04)

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