198019099-12-2-2022-33-CC-AEIN-CLQUTU-20221202145232

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019099
Report Date: 12/02/2022
Date Signed: 12/02/2022 02:52:37 PM

Document Has Been Signed on 12/02/2022 02:52 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:	SHAHNAZARYAN FAMILY CHILD CARE		FACILITY NUMBER:	198019099
ADMINISTRATOR:	LIANNA SHAHNAZARYAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 523-6580
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91202
CAPACITY:	14	CENSUS: 12	DATE:	12/02/2022
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Lianna Shahnazaryan, Licensee		TIME COMPLETED:	03:10 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	CASE- MANAGEMENT INCIDENT INSPECTION CONDUCTED IN ARMENIAN Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced case management inspection on 12/02/2022 at 1:20 PM, due to an incident that occurred on Wednesday, 11/16/2022. LPA met with Lianna Shahnazaryan, licnesee at 1:20 p.m. who guided analyst on a tour of the facility. During this inspection Sevada Antonyan and Meline Sargsyan, licensee's assistants were also present in the home. During this inspection LPA observed 12 children in the bedroom getting ready to take nap. Alleged Incident took place on 11/16/22. Incident was reported via telephone next working day on 11/17/22. Original LIC 624 Unusual Incident/Injury Report form was received by the Department within 7 days. The written incident report was received by email on Thursday 11/17/22. During this inspection Licensee also provided a copy of fax confirmation that written incident report was faxed to the Department on 11/18/2022. The facility did report the incident within the required 24 hour time frame. LPA observed the area where alleged incident took place on 11/16/22. (Pictures were taken). Per licensee, on 11/16/22 during nap time, around 2:00-2:10 p.m when all children were inside the home and napping, due to the high wind and electricity issues the roof of the off-limit detached garage (guest house) caught in the fire. Per licensee, 12 children were napping and 2 school age children were awake. Licensee took 14 present children outside to the front yard in her car and all the parents were called and all children were picked up till 3:15 p.m.. All children were safe. Per licensee, facility was closed on 11/17/22. Per licensee, Fire Department was called and they came to the home while children were in the licensee's car in the front of the home. Police was called and they came to the facility as well. Per licensee, she had an inspection by City of Glendale Fire Prevention Bureau on 11/17/22. Per licensee, her house power came back on 11/17/22 and facility was open as of 11/18/22. REPORT CONTINUES ON NEXT PAGE 1 of 2

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2022

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: SHAHNAZARYAN FAMILY CHILD CARE	FACILITY NUMBER: 198019099
	VISIT DATE: 12/02/2022

NARRATIVE

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LPA obtained a copy of facility current roster and a copy of Fire Prevention Bureau inspection report that was completed by Inspector Fieda on 11/17/22.

During this inspection licensee shared an email that she received from Antonino Abejo, Principal Inspection Supervisor from City of Glendale on 12/01/22 that "Red Tag" will change into "Yellow Tag" to allow to remove trash and debris as a result of the fire. During this inspector Mohler came to the facility and posted "Yellow Tag" to allow Limited Entry in the detached garage.

Per licensee, currently she is not taking children outside to the backyard for outdoor activity and children stay inside in the main home until she cleans the backyard and make it safe for the children. Per licensee, she will contact LPA Eivazian prior to start to take the children to the backyard for outdoor activity and pictures will be submitted.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today from the areas that were inspected today.

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, Lianna Shahnazaryan at 3:10 p.m..

REPORT END 2 of 2

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2022

LIC809 (FAS) - (06/04)

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