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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019932
Report Date: 10/06/2022
Date Signed: 10/06/2022 12:45:18 PM


Document Has Been Signed on 10/06/2022 12:45 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: 13DATE:
10/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Assistant, Marina SosyanTIME COMPLETED:
01:00 PM
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At approximately 9 am, Licensing Prorgram Analysts (LPA's), Bardo Baluyot and Anomeh Eivazian conducted an unannounced required annual inspection to the above facility. At 9:03am, LPA's met with Marine Sosyan, Assistant. LPA's conducted a COVID risk self-assessment upon entry. Licensee, Taron Mayilyan was not present. Upon arrival, Ms. Sosyan stated that LPA Eivazian was not allowed to be at the facility according to previous informal meeting but LPA stated that LPA Eivazian is only assisting with translation and not conducting the inspection. Ms. Sosyan then left to attend to other LPA's conducting an inspection next door which is licensed to the Licensee's parents. At 9:15am, Licensee Taron Mayilyan joined LPA's stating that he was tending to some personal matters. At approximately, 10 am Licensee's father, Tigran Mayilyan arrived at the facility and reminded LPA Baluyot that LPA Eivazian was not to be at the facility and to please not anger Licensee. However, Licensee, stated that he would allow this one exception as there was a new LPA conducting the inspection. The licensee states that he is unsure of how many children are enrolled due local schools being back in session. A current children’s roster was available but Licensee stated that it is not current due to local schools being back in session. Per Licensee, current hours of operation are 7am-6pm, Monday-Friday. LPA's provided form LIC 279 to update hours of operation. At approximately 12 PM, Licensee stated that he disagrees with half of what is mentioned on this report as he observed LPA Eivazian also conducting the inspection along with LPA Baluyot. At approximately 12:04 LPA's recounted the children and observed 13 children present. Per Licensee, children present range from ages 1/5 -5.5 years old and that no children present are 6 years old or enrolled in Kindergarten. At approximately, 12:08 PM, facility was observed to be operating over ratio with one child. Licensee was not able to provide proof of child's enrollment into a TK program. At this time, Licensee requested to have his signature removed from report and LPA Baluyot agreed. Per Licensee, this is due to him having a signed document stating that LPA Eivazian was not allowed to be within 50 ft of the facility and after observing her participation in the inspection.

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 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 have 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 9:25am, 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.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo BaluyotTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/06/2022
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 7


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: 10/06/2022
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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 adequately barricaded and made inaccessible to children. Smoke/carbon monoxide detector in hallway was tested and is 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.

This facility shares a backyard outdoor space with next door facility (#)198018963. Per licensee, backyard schedule for play time 11am-12pm for this facility. Licensee states Facility 198018963 uses outdoor space at 1pm. At 10 am, a fire extinguisher adjacent to the kitchen was observed to have a purchase date of 8/31/2021. However, the valve on the required 2A 10BC fire extinguisher indicates that it is still fully charged. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. The licensee is observed to be operating within the license capacity limitations.



FACILITY RECORDS:
Assistant, Marine Adamyan's Pediatric First Aid and CPR expires on 3/26/24. Licensee and other personnel have mandated reporter training certificates that expired 3/27/24. 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 seven of twelve children present without child files available for review at facility. Per licensee, they have not yet obtained all the paperwork from the parents due to local schools just starting.

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 childcare facility.
-Smoking is prohibited in a license family childcare home.

PG 2 of 2
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo BaluyotTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
LIC809 (FAS) - (06/04)
Page: 2 of 7
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: 10/06/2022
NARRATIVE
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Infant Care: Licensee states that they do not currently care for infants. However, per Licensee, one child, Timothy Zubanov will be turning two by the end of this month. Child did not have a file available for review to verify DOB. 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. Per Licensee, staff is always present to provide constant supervision in the room when children are napping.

LPA discussed the safe sleep regulations with licensee Taron Mayilyan 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 Taron Mayilyan 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.

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

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



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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo BaluyotTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
LIC809 (FAS) - (06/04)
Page: 3 of 7
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: 10/06/2022
NARRATIVE
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LPA Baluyot informed Licensee, Taron Mayilyan that this report dated 10/6/22 document(s) 1 Type A citation. Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Baluyot informed the licensee Taron Mayilyan to provide a copy of this licensing report dated 10/6/22 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee, Taron Mayilyan. Plan of Corrections was developed and also reviewed with Licensee.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

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END OF REPORT

SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo BaluyotTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
LIC809 (FAS) - (06/04)
Page: 4 of 7
Document Has Been Signed on 10/06/2022 12:45 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: 10/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in 7 out of 12 children's files did not have proper documents including immunizations records on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/07/2022
Plan of Correction
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Licensee states that he will acquire current immunizations for all children enrolled by POC date.
Type B
Section Cited
CCR
102421(a)
Immunizations

(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on file review and interview with Licensee, the licensee did not comply with the section cited above in 7 out of 12 children did not have files available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/07/2022
Plan of Correction
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Per Licensee, children's files will be updated by POC date.

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: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo BaluyotTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 10/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/06/2022
LIC809 (FAS) - (06/04)
Page: 5 of 7


Document Has Been Signed on 10/06/2022 12:45 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: 10/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(8)
(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:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above and not having an updated faciliyt roster available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/07/2022
Plan of Correction
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Per Licensee, facility roster will be updated by POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo BaluyotTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 10/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/06/2022
LIC809 (FAS) - (06/04)
Page: 6 of 7


Document Has Been Signed on 10/06/2022 12:45 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: 10/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(d)(2)(a)

(2) Health and Safety Code section 1597.465 states:

A large family day care home may provide care for more than 12 children and up to and including 14 children, if all of the following conditions are met:

(a) At least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observationat approximately 12 pm when the children returned from outside play, the licensee did not comply with the section cited above and observed 13 children present which makes facility out of ration by one child which poses an immediate health, safety or personal rights risk to persons in care. Children present were observed to be ranging from ages 1.5-5.5.
POC Due Date: 10/07/2022
Plan of Correction
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Per Licensee, 13th child is enrolled in a TK program but Licensee was unable to provide proof of enrollment. Per LIcensee, he does not need to provide proof of enrollment.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo BaluyotTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 10/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/06/2022
LIC809 (FAS) - (06/04)
Page: 7 of 7