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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019932
Report Date: 03/17/2022
Date Signed: 03/17/2022 12:31:49 PM


Document Has Been Signed on 03/17/2022 12:31 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, 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: 11DATE:
03/17/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Marina Adamyan TIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Judy Mora conducted an unannounced required inspection at the above facility on 03/17/22. The purpose of this inspection is to ensure that the facility is in compliance with Title 22 regulations and the facility Compliance Plan set it place on 09/08/21. LPA arrived at the facility at 8:40 AM. Upon arrival LPA was greeted by Marina Sosyan, who lives in the facility next door. Licensee, Taron Mayilyan, was not present at the time of arrival. Ms. Sosyan proceeded to go next door to her facility, lic #198018963, 524 Chevy Chase Dr. Glendale, CA 91205 where LPA's Nolan Tcheng and David Kurdoglyan follwed. LPA Mora was let into this facility at 8:48 AM by Marine Adamyan, Licensee's assistant. Licensee, Taron Mayilyan, arrived at approximately 8:58 AM. Licensee's father, Tigran Mayilyan was also present during this inspection. There was one infant present at the time of arrival. Ten children arrived during this inspection.

This is a one-story home which consists of 03 bedrooms, 1 1/2 bathrooms, kitchen, living room, dining room, laundry area, detached garage, front yard and backyard (fenced). Per Licensee, areas off limits to children and parents include: kitchen, one bedroom, one restroom and detached garage. There is a kiddie gate blocking access to kitchen on one side. LPA advised Licensee to place another kiddie gate in the other doorway to the kitchen. The Licensee's yard is shared with Mayilyan and Sosyan FCC. Per Licensee the children play outside from 12:00 PM to 1:00 PM. Per Licensee hours of operation vary but are usually Mon-Fri 8:00 AM - 6:30 PM. Food is provided by Licensee. Children use the bathroom next to the dining room.

Individuals residing in the home have been discussed and noted. All adults present in the home have obtained a criminal record clearance or exemption.

LPA observed the following required posted documentation in the main entry way of the facility: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA reviewed facility records for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log. Last drill was conducted on 08/18/21, more than 6 months ago.


*REPORT CONTINUES ON NEXT PAGE
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:
DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/17/2022
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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Document Has Been Signed on 03/17/2022 12:31 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, 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: 03/17/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/27/2022
Section Cited

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Operation of a Family Child Care Home
Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
This requirement was not met as evidenced by facility file review.
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LPA observed that the roster is not current, 4 children present today are not listed, C2, C3, C9 & C10. This is a potential risk to the health and safety of children in care.
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Type B
03/27/2022
Section Cited

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Operation of a Family Child Care Home
Each family child care home shall conduct fire drills and disaster drills at least once every six months.
This requirement was not met as evidenced by file review, last drill documented was 08/2021, more than the six month requirement. This is a potential risk to the health and safety of children in care.
Type B
03/27/2022
Section Cited

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Posting licensing report by child care facility or home; duration of posting; civil penalty for failure to comply; reports to be provided to parents or guardian of each child receiving services
The licensee shall require each recipient of the licensing document pertaining to a conference to sign a statement indicating that he or she has received the document and the date it was received.
This requirement was not met as evidenced by review of children's records. No child file has a LIC 9224 on file from The office informal meeting held on 09/08/21. This is a potential risk to the health and safety of children 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: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:
DATE: 03/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/17/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/17/2022 12:31 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, 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: 03/17/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/27/2022
Section Cited

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Child's Records
The licensee shall maintain, in each child's record, a copy of the emergency information card as required in Section 102417(g)(7).
This requirement was not met as evidenced by child record review. LPA observed that C2, C3, C9, C10 & C11 do not have files. This is a potential risk to the health and safety of children in care.
Type B
05/01/2022
Section Cited

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 Availability of information regarding detecting and reporting child abuse and neglect; etc.
On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated
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reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
This requirement was not met as evidenced by facility file review of staff records. The Licensee's assistant does not have a current Mandated Reporter certificate on file. This is a potential risk to the health and safety of children in care.
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Type B
04/17/2022
Section Cited

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Personnel Requirements
The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
This requirement was not met as evidenced by facility file review of staff records. The Licensee's assistant does not have a Pediatric First Aid & CPR certification on file. The Licensee's assistant was observed to be alone with children for approximately 10 minutes. This is a potential risk to the health and safety of children 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: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:
DATE: 03/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/17/2022
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MAYILYAN FAMILY CHILD CARE
FACILITY NUMBER: 198019932
VISIT DATE: 03/17/2022
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LPA observed on children's roster that 4 children present during this inspection are not noted on the roster, C2, C3, C9 & C10.

Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged, purchased on 08/03/21 (receipt attached). The home maintains telephone service via cell phone. The home is observed to be clean and orderly. There are toys and other age appropriate material available for children.

LPA observed one fireplace, in the living room that is off limits to children. LPA observed that there are no detergents, cleaning compounds or medication's accessible. Licensee states that there are no poisons stored in the home. Isolation area for sick children waiting to be picked up is in one of the bedrooms if necessary, away from the other children. Per Licensee there are no firearms or weapons stored in the home.

Infant Care: Per Licensee, there is one infant enrolled. LPA informed licensee of the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months. Licensee does not have a file for the infant in care. Licensee could not verify the DOB for the infant observed at facility. Licensee states the child observed, C2 is not an infant.

Currently children are using the backyard yard for outdoor play. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA asked Licensee to throw out 2 car toys that were noticeably broken and cracked to prevent any injury. Licensee agreed.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months). LPA reviewed children's files to ensure that LIC 9224, Acknowledgement of Receipt of Licensing Report is on file for Office meeting held on 09/08/21. No children present have the LIC 9224 on file. LPA observed that C2, C3, C9, C10 & C11 do not have files.




*REPORT CONTINUES ON NEXT PAGE
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: 03/17/2022
NARRATIVE
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Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC 508- Criminal Record Statement, Proof of immunization's against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate. The Licensee has current Pediatric First Aid and CPR which expires 08/14/23. The Licensee also has the current mandated reporter certificate dated 08/11/21. However, the Licensee's assistant does not have the Pediatric First Aid & CPR certification nor the Mandated Reporter certificate on file.

At approximately 10:15 AM LPA was now outside of the facility on the front porch, LPA asked Licensee if he wanted to go inside to be with the assistant and children since there were 10 children present with only the assistant. The Licensee said no. LPA advised Licensee that he was out of ratio. At 10:40 he called his mother, Marine Sosyan, and asked her to go assist his assistant.

LPA observed that licensee is implementing COVID-19 precautions and procedures. Children and Licensee's assistant were observed to not be wearing masks.

Incidental Medical Services (IMS):
Incidental Medical Services (IMS) policy was discussed. Per Licensee, there are no children on medications. 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

*REPORT CONTINUES ON NEXT PAGE

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: 03/17/2022
NARRATIVE
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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22 and/or the Health and Safety Code. Please see attached LIC 809d. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.



A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Taron Mayilyan.

*END OF REPORT

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022
LIC809 (FAS) - (06/04)
Page: 6 of 6