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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100143
Report Date: 09/28/2021
Date Signed: 09/28/2021 10:25:57 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:BAGIRYAN, IRINA FAMILY CHILD CAREFACILITY NUMBER:
376100143
ADMINISTRATOR:IRINA BAGIRYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(517) 490-6878
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:14CENSUS: 11DATE:
09/28/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Irina BagiriyanTIME COMPLETED:
10:30 AM
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On 9/28/2021 at 10:00 AM Licensing Program Analyst (LPA) Adrian Mangina conducted an unannounced case management inspection for the purpose of providing an amended report initially provided an 9/1/21. LPA met with Licensee Irina Bagiryan. Also in the home was Assistant Andrea Landeros. There were eleven children in care. Proper supervision and ratios were observed.

No deficiencies were cited during this visit.

An exit interview was conducted with the Licensee. The Licensee was provided a copy of their appeal rights (LIC 9058) along with a copy of this the report (LIC809) their signature on this form acknowledges receipt of these rights. LPA observed LIC 9213 (Notice of Site visit) was posted during today's visit. Notice of Site Visit must remain posted for 30 days
SUPERVISOR'S NAME: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Adrian L ManginaTELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021
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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