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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019932
Report Date: 08/03/2021
Date Signed: 08/03/2021 11:49:01 AM

COMPREHENSIVE INSPECTION
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:TARON MAYILYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 749-1188
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:14CENSUS: 10DATE:
08/03/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:03 AM
MET WITH:Taron Mayilyan - LicenseeTIME COMPLETED:
11:58 AM
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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced annual required inspection to the above facilit. At 9:03am, LPA met with Tigran Mayilyan, Assistant, who stated Licensee was in the back. At 9:09am, Licensee Taron Mayilyan joined LPA from front of house stating they were getting an item from their car. The licensee states that he currently has 12 children enrolled. A current children’s roster is available but is current. Licensee’s hours of operation are 8am-5pm, Monday-Friday.

This is a one-story home which consists of 3 bedrooms, 2 bathrooms, kitchen, dining room, living room, front yard and backyard (fenced). The children use bedroom #1, Bedroom #3, bathroom in hallway leading to backyard, living room, dining room area and backyard. Per licensee, areas off limits to children and parents include: bedroom #2 (office), kitchen, bathroom in inside hallway and front yard. The licensee provides food for children in care. The licensee states that only 1 adult currently lives in the home. Licensee states that they currently has two assistants. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. Per licensee, there are no weapons, firearms or bodies of water on the premises

At 9:12am, LPA was lead on a tour of the facility by the licensee. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are observed to be posted. Detergents, cleaning compounds, medications, and other items which could pose a danger are inaccessible to children. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock. Per licensee, Bedroom #1 will be used as an area for an ill child until an authorized representative comes to pick up child. There are first aid supplies available. Fireplaces and open face heaters are inaccessible to prevent access by children. Smoke and carbon monoxide detectors were tested and are operable. The licensee states that a cell phone is used and stays at the facility during operating hours. At 9:20am, LPA observed the back yard area. The outdoor play area was observed to be fenced. At this time, children are using the back yard for outdoor play time. REPORT CONTINUES PAGE 1 of 3
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 198019932
VISIT DATE: 08/03/2021
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This facility shares an backyard outdoor space with facility 198018963. Per licensee, backyard schedule for play time 11am-12pm for this facility. Licensee states Facility 198018963 uses outdoor space at 1pm. At 9:40am, a fire extinguisher was observed. The valve on the required 2A 10BC fire extinguisher indicates fully charged. Fire Extinguisher was purchased on 04/29/2019, as indicated on receipt attached. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. Per licensee, the fire extinguisher was serviced but they misplaced the service tag. LPA reminded licensee that the tag should remain attached to the fire extinguisher. The licensee is observed to be operating within the license capacity limitations.

FACILITY RECORDS:
The licensee and other personnel have not completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expired 05/2020. Licensee states they will be completing CPR/First Aid Training by next week. Licensee and other personnel have mandated reporter training certificates that expired 04/2021. The licensee has proof of immunization against influenza, tuberculosis, pertussis, and measles. Children’s records were reviewed, including but not limited to, a copy of the emergency information card that contains all the information specified by regulation. LPA observed five of seven children without child files present at facility. Per licensee, they have not yet obtained all the paper work from the parents.

The following was discussed:
-Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately.
-There are no pets on the premises
-Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that falls into these categories are not permitted in a family child care facility.
-Smoking is prohibited in a license family child care home.

Infant Care: Licensee states that they do not currently caring for infants. LPA advised the licensee to sleep infants where they can be directly supervised at all times and advised the licensee against sleeping infants in a separate room.
REPORT CONTINUES PAGE 2 of 3
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 198019932
VISIT DATE: 08/03/2021
NARRATIVE
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LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS. LPA consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices. PIN 20-24-CCP was provided and explained during the inspection.

Incidental Medical Services (IMS):
Per licensee, there are no children enrolled that require IMS at this time. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA observed that a COVID-19 Technical Assistance call had been made on 08/20/2020.
LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov. AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/

Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety



The Notice of Site Visit (LIC 9213) – must remain posted for 30 day during the hours of operation after each site visit made by a licensing representative.

Exit interview was conducted with Taron Mayilyan, licensee, and Plan of Corrections were reviewed and developed. A copy of the report was provided.

END OF REPORT PAGE 3 of 3

SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 198019932
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/06/2021
Section Cited

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102421 Child's Records
(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required...

This requirement is not met as evidenced by:
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Based on observation and interview, licensee did not ensure 7 of 9 children present at the facility have files with required documentation prior to children attending. This poses a potential risk to the health, safety, and personal rights of children in care.
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Type B
08/06/2021
Section Cited

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102417 Operation of Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
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Based on Observation, interview, and file review, Licensee did not ensure that the Child Care Facility Roster was kept up to date with current children enrolled. This poses a potential risk to the health, safety, and personal rights of 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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2021
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 198019932
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/06/2021
Section Cited

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102417 Operation of Family Child Care Home
(1) ...The home shall contain a fire extinguisher...which meet standards established by the State Fire Marshal.

This requirement is not met as evidenced by:
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Based on observation and interview, Licensee did not ensure that fire extinguisher in the home is serviced annually and maintains proof of service. Receipt present on fire extinguisher notes a purchase date of 04/29/2019. This poses a potential risk to the health and safety of children in care.
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Type B
08/06/2021
Section Cited

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"1596.8662(d)(1) Health and Safety Codea person who is a licensed child care provider... of a licensed child day care facility shall complete the mandated reporter training, complete renewal... every two years following the date on which he or she completed...

This requirement is not met as evidenced by:
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Based on interview and file review, Licensee did not ensure that all personnel at the facility have an up to date Mandated Reporter Training Certificate. Training expired 04/2021 for personnel and Staff #1 does not have proof of training present. This poses a potential risk to the health, safety, and personal rights of 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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2021
LIC809 (FAS) - (06/04)
Page: 5 of 5