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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020183
Report Date: 06/16/2023
Date Signed: 06/16/2023 02:17:25 PM


Document Has Been Signed on 06/16/2023 02:17 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:ADAMYAN FAMILY CHILD CAREFACILITY NUMBER:
198020183
ADMINISTRATOR:ANNA ADAMYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 507-9068
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:14CENSUS: 8DATE:
06/16/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Anna Adamyan, LicenseeTIME COMPLETED:
02:30 PM
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CASE MANAGEMENT INSPECTION CONDUCTED IN ARMENIAN

Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced case- management inspection to the above facility on 06/16/23 to follow up on one Type A deficiency that was issued on 05/15/23. LPA arrived at the facility at 1:20 PM and met with Anna Adamyan, Licensee who guided analyst on a tour of the facility. Also present during this inspection, was Silva Martirosyan, Licensee’s Assistant.

Upon LPA's arrival to the facility licensee opened the main entrance door which leads to the living room. LPA observed 8 children were napping in in the main home in the living room with licensee and her assistant.
Per licensee children sleep inside the main home in the living room and eat either outside in the backyard or inside the home.

Acknowledgement forms were observed for all children in care.

LPA cleared deficiency on this date and provided a copy of Plan of Correction clearance letter.



The Notice of Site Visit (LIC 9213) 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, Anna Adamyan at 2:30 PM.


SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:
DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2023
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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