197494654-11-16-2021-30-CC-SGAN-C8TTYF-20211116140840

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494654
Report Date: 11/16/2021
Date Signed: 11/16/2021 02:09:42 PM

Document Has Been Signed on 11/16/2021 02:09 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 CARE		FACILITY NUMBER:	197494654
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 6	DATE:	11/16/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	12:41 PM
MET WITH:	Armine Simonyan/Licensee		TIME COMPLETED:	02:05 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Visit Conducted In Armenian Licensing Program Analyst (LPA) Silva Garibyan conducted an announced Case Management Increase Capacity Inspection on November 16, 2021 at 12:40 P.M.. LPA met with Armine Simonyan, Licensee and toured the home inside and outside. The licensee has applied for Capacity Increase. LPA reviewed the file of licensee verifying that licensee has more than one year experience operating a Small Family Child Care Home. The Fire clearance was granted on 10/22/2021. Capacity and Ratios: The licensee has applied for a capacity increase for a Large Family. The Max capacity is 14 with no more than 4 infants and a qualified assistant. Without a qualified assistant the license reverts back to the requirements for a small family childcare. Optional care may be provided for a maximum capacity of 14 children with no more than 3 infants, 2 school age children and a qualified assistant. School age children must be; 1 child of 6 years old and 1 child in Kindergarten. Hours of operation are from 7:30AM - 5:30PM (Monday-Friday). Per the licensee there has been no noted changes to the home or occupants since her last visit (Plan of Correction visit conducted on 09/16/21.), the facility remains in substantial compliance at this time. Present were licensee and one employee, with 6 preschool age children. LPA observed children eating lunch in the main house. LPA observed Licensee's current Pediatric CPR (Adult/Infant /Child) and Pediatric First Aid certification (expire 07/24/2022). Page 1 of 3

SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021

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: 11/16/2021

NARRATIVE

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Licensee has the required documents posted in the FCCH; Facility License (LIC 203), Emergency Disaster Plan (LIC610A), Notification of Parents' Rights Poster (PUB 394), Child Care Facility Roster (LIC9040), If You see Something Say Something, Car Seat Safety, COVID-19 posters.
LPA reviewed assistant's and children's files.

The home was found to be clean and orderly with proper ventilation for safety and comfort. The bathroom was inspected for inaccessibility of chemicals/toxins and other potential hazards to children in care. The Fire Extinguisher (2-A:10-B:C) is mounted on the wall in the hall way and inaccessible to children in care. There is a working smoke/Carbon Monoxide detector located in the hall way.

LPA observed toys and furniture that were age appropriate and in good repair. LPA toured the backyard and found it to be fully fenced. Children's outdoor play equipment and toys are age appropriate and in good repair.

Licensee was informed of responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000. Also call the Community Care Licensing office and follow up with a written Unusual Incident/Injury Report (LIC 624B).

LPA discussed and provided safe sleep for your baby pamphlet. LPA recommended that infants shall be lay on the back during sleep time.
The licensee was informed that the presence of adults in the home without Criminal Record Clearance or Exemption will be cited and civil penalty assessed for $100 per day.
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SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021

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: 11/16/2021

NARRATIVE

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The licensee may find additional information and forms on the Department’s website at www.ccld.ca.gov including information on the Live Scan application (LIC 9163). Appointments can be made for Live Scan at 1-800-315-4507.

LPA reviewed current Fire Drill and Emergency Log. LPA discussed the requirement of a monthly Fire Drill with the increase capacity to a Large.

LPA discussed AB633 and informed licensee that, upon receipt of a Type A deficiency, the licensee shall post and provide copies of this licensing report to parent/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

Licensee is reminded that smoking is prohibited on the premises during hours of operation.

No Deficiencies are being cited on this date.

An exit interview was conducted and a copy of the report was provided.

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SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021

LIC809 (FAS) - (06/04)

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