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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019932
Report Date: 10/07/2020
Date Signed: 10/07/2020 11:11:08 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:MAYILYAN FAMILY CHILD CAREFACILITY NUMBER:
198019932
ADMINISTRATOR:TIGZAN MAYILYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 749-1188
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:14CENSUS: 9DATE:
10/07/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Taron Mayilyan, LicenseeTIME COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA) Thelma Razo, LPA Anomeh Eivazian, and Licensing Program Manager (LPM) Ana Chico conducted an unannounced Case Management - Other. During the course of complaint investigation, LPA followed up on possible personal rights violations that may have occurred at this facility. LPAs and LPM met with Licensee Taron Mayilyan and stated the purpose of the visit.

LPA Eivazian interviewed 3 children and one staff in Armenian. LPA Razo interviewed Licensee Taron Mayilyan in English.

No deficiencies were cited at this time. Exit interview conducted with Licensee Taron Mayilyan. Appeal Rights explained.

The Notice of Site Visit (LIC 9213) was provided and 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.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Thelma RazoTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2020
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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