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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019879
Report Date: 02/09/2024
Date Signed: 02/09/2024 03:18:35 PM

Document Has Been Signed on 02/09/2024 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:SAHINYAN FAMILY DAY CAREFACILITY NUMBER:
198019879
ADMINISTRATOR:NONA SAHINYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 484-5184
CITY:GLENDALESTATE: CAZIP CODE:
91203
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 8DATE:
02/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Nona Sahinyan, LicenseeTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced case management inspection on 02/09/24 at 1:10 PM, due to an incident that occurred on Wednesday, 12/06/23. LPA met with Nona Sahinyan, Licensee who guided analyst on a tour of the facility. During this inspection licensee's assistant, Kristine Manukyan was also present in the home. LPA observed 8 children were present in the facility during this inspection, napping in the living room (main daycare area).

Alleged Incident took place on 12/06/23. Incident was reported via email next working day. 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 12/07/24 at 10:01 PM. The facility reported the incident within the required 24 hour time frame.

LPA observed the area where alleged incident took place. Per licensee, Nona Sahinyan, during indoor free playtime on 12/06/23 approximately at 10:30 AM, child#1 fell from the couch. Per licensee, child#1, was bouncing up on the couch, fell down and landed on right upper arm. Per licensee, her assistant, Kristine Manukyan was right next to child#1, unfortunately, the fall happened so quickly and unexpectedly that she could not prevent the fall. Per licensee, child#1, only cried a little and had no swelling or bruising. Per licensee, after fall child#1 was holding right arm, parent#1 was contacted right away, ice was applied on child#1's right arm. Child#1 took nap, participated in snack time. During pick up time, when child#1's was held by uncle, child#1 started crying. Child#1 was taken to Urgent Care on 12/07/23, and sustained a fracture in right clavicle. Child#1 was given a shoulder immobilizer. Per licensee, child#1 came back to facility on 12/11/23. Per licensee, as of 01/10/24 should immobilizer was removed from child#1's shoulder. LPA obtained copies of Urgent care reports dated 12/07/23 and 01/10/24. Pictures were taken from area where the incident occurred.
REPORT CONTINUES ON NEXT PAGE 1 of 2
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2024
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: SAHINYAN FAMILY DAY CARE
FACILITY NUMBER: 198019879
VISIT DATE: 02/09/2024
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During this inspection LPA reviewed facility sign in/out sheet on licensee's ipad. On 12/06/23, 10 children were present at the facility with licensee and her assistant, Kristine Manukyan. Ratio and staffing were in accordance of Title 22 Code of Regulations at the time of the incident.

LPA issued the Confidential Names List (LIC 811) to the licensee during this inspection. The Confidential Names List documents the staff and children involved with the incidents documented in this report.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued 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, Nona Sahinyan at 3:30 p.m..


REPORT END 2 of 2
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024
LIC809 (FAS) - (06/04)
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