197494694-8-15-2023-58-CC-LHEZ-CUQS9U-20230815134118

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494694
Report Date: 08/15/2023
Date Signed: 08/15/2023 01:41:25 PM

Document Has Been Signed on 08/15/2023 01:41 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	MIRZOYAN FAMILY CHILD CARE		FACILITY NUMBER:	197494694
ADMINISTRATOR:	MIRZOYAN, LUSINE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 448-5247
CITY:	BURBANK	STATE: CA	ZIP CODE:	91501
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 9	DATE:	08/15/2023
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:47 AM
MET WITH:	Lucine Mirzoyan, Licensee		TIME COMPLETED:	01:45 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	Licensing Program Analyst (LPA) Lilia Hernandez conducted an unannounced annual required inspection to the above facility on 08/15/2023. LPA arrived at the facility at 10:47AM, identified self and met with Lucine Mirzoyan, Licensee who guided analyst on a tour of the facility. There were 9 children present at arrival. Also present was Staff #1 (S1). LPA was later met with Licensee adult daughter, who is associated to the facility. LPA provided Licensee with a copy of the LIC 125 Entrance Checklist to help facilitate the inspection. Facility operation hours are Monday to Monday from 12:01 AM to 11:59 PM. The family child care home is a 3 bedroom, 2 bathroom, living room, dining room, and kitchen. LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed, and Licensee confirmed that one bedroom, one bathroom and living room are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of safety door knobs. LPA observed no swimming pool or other bodies of water on the premises. Per Licensee, there are no firearms or ammunition on the premises. All poisons are kept in a locked storage area. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. The fireplace located in the living room is made inaccessible by a screen. Per Licensee, fireplace is not used and a shelf to store children’s toys and books is placed in front of the fireplace. There is a working fire extinguisher, smoke detector, carbon monoxide detector (livingroom) and adequate heating and ventilation for safety and comfort. There are currently no infants in care. LPA discussed Safe Sleep Regulations with licensee. ---page 1 of 3

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

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 4

Document Has Been Signed on 08/15/2023 01:41 PM - It Cannot Be Edited

Created By: Lilia Hernandez On 08/15/2023 at 01:24 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MIRZOYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494694
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/15/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416.1(d)

Personnel Records

(d) All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 3 of 3 staff did not have a personnel file available for LPA to review which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/29/2023
	Plan of Correction
1 2 3 4	Per licensee, documents will be collected, scanned, emailed to LPA and submitted by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Rita Ramos

LICENSING EVALUATOR NAME:

Lilia Hernandez

LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MIRZOYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494694
	VISIT DATE: 08/15/2023

NARRATIVE

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LPA discussed the safe sleep regulations with licensee 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 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.

Licensee was reminded that children in care are to be supervised at all times and made aware that children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children.

The outdoor play area is located on the side of the house, is fenced and there are no hazards to children present. The backyard is off- its to children. Licensee was advised to submit an updated facility sketch to include the off-limit areas in the back yard.

Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete and documented on the LIC857.

An emergency fire/disaster drill has been completed and documented within the last 6 months (8/4/2023). Licensee’s Mandated Reporter Training was completed on 12/23/2021. Licensee’s pediatric CPR/First Aid expires on 12/17/2024.

There were no personnel records for LPA to review.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. --page 2 of 3

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MIRZOYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494694
	VISIT DATE: 08/15/2023

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

The following deficiencies listed on the attached deficiencies page are being cited in accordance with California Code of Regulations Title 22.
A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the Lucine Mirzoyan, Licensee. Page 3 of 3

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

LIC809 (FAS) - (06/04)

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