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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494654
Report Date: 09/16/2021
Date Signed: 09/16/2021 03:18:22 PM

Document Has Been Signed on 09/16/2021 03:18 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:SIMONYAN FAMILY CHILD CAREFACILITY NUMBER:
197494654
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
09/16/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Armine Simonyan/LicenseeTIME COMPLETED:
01:35 PM
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On 09/16/21 at 12:55pm, Licensing Program Analyst (LPA) Silva Garibyan conducted an unannounced Plan of Correction (POC) visit. Upon arrival LPA met with the Licensee Armine Simonyan, LPA discussed the purpose of today's visit. LPA indicated that today’s visit was a follow up on deficiencies that were observed during the annual visit on 08/31/21 by LPA Antonio Almanza. There are 4 children in care during today's visit.
Licensee was cited for the following deficiencies:
1) 102421 Child's Records (b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required in Section 102417(g)(7): Based on observation, interview and record review, The Licensee did not have emergency information for 9 children enrolled
2) 102417 Operation of a Family Child Care Home (g)(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.84: Based on observation, interview and record review, The Licensee does not have a facility roster for 9 children enrolled
3) 102416.5 Staffing Ratio and Capacity (a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time: Based on observation, interview and record review, The Licensee did not adhere to her Licensed capacity, LPA observed 9 children in care.
4)102417 Operation of a Family Child Care Home (a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times: Based on observation, interview and record review, The Licensee did not ensure children in care are supervised at all times, LPA observed 7 children sleeping in the back building unsupervised and 2 children inside the main home unsupervised.

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SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE: DATE: 09/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SIMONYAN FAMILY CHILD CARE
FACILITY NUMBER: 197494654
VISIT DATE: 09/16/2021
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LPA Garibyan toured the facility with the licensee and observed four children present in the facility. LPA observed the Acknowledgement of Receipt of licensing Reports LIC9224 with parents signatures.

During POC visit on 09/16/21 LPA observed that Licensee has a current roster for 6 children enrolled. LPA reviewed six children’s files and observed files were complete with emergency information as required. Licensee is fully aware that children may not eat or sleep in the back building. Children will eat in the living room and sleep in the bedroom in the main house.

At the time of the Plan Of Correction visit the facility was found to be in substantial compliance. LPA observed the Notice of site visit and Facility Evaluation Report ( LIC809 and LIC809-D) posted on the parent board.


Exit interview was conducted, no deficiencies were cited during today’s visit. A copy of the report and POC letter was provided to Licensee.

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SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021
LIC809 (FAS) - (06/04)
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