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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019932
Report Date: 10/21/2022
Date Signed: 10/21/2022 03:15:23 PM

Document Has Been Signed on 10/21/2022 03:15 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:MAYILYAN FAMILY CHILD CAREFACILITY NUMBER:
198019932
ADMINISTRATOR:TARON MAYILYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 749-1188
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
10/21/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:49 PM
MET WITH:Licensee, Taron MayilyanTIME COMPLETED:
03:15 PM
NARRATIVE
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On October 21, 2022 at 1:40PM Licensing Program Analysts (LPAs) Monique Ayala and Bardo Baluyot conducted an unannounced Case Management Inspection – Plan of Correction at the above facility. A COVID-19 risk assessment was conducted prior to entering the facility. LPAs met with at Assistant, Marina Sosyan who guided LPA's on a tour of the facility. LPAs observed 11 children in care, at 1:45 AM. Licensee,Taron Mayilyan, arrived at approximately 1:50 PM. The purpose of this inspection is to ensure that the facility is in compliance with Title 22 Regulations and the deficiencies cited on 10/06/2022 were corrected.

Licensing staff observed and reviewed the following:

· The facility is within proper ratio/capacity

Letters of Deficiency Citation Cleared was provided for the deficiency corrected.

Licensing staff observed and reviewed the following:

  • The facility does not have a current facility roster for the children enrolled
  • The facility does not have files for all children enrolled; LPAs observed 8 files out of the 11 children enrolled.
  • The facility does not have current immunization for 2 children enrolled.

LPAs observed that the the above deficiencies have not been corrected. Licensee stated that he has not updated the facility roster due to the children's school schedule. Licensee stated that he has given the families the packets of licensing documents, but the families have not returned them.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Bardo Baluyot
LICENSING EVALUATOR SIGNATURE: DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: MAYILYAN FAMILY CHILD CARE
FACILITY NUMBER: 198019932
VISIT DATE: 10/21/2022
NARRATIVE
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The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00

Licensee was informed that signing this report acknowledges receipt of the report and is not admission to or agreeing with any of the statements within the content of the report.

An exit interview was conducted, and a copy of this report was provided to Taron Mayilian. LPAs provided licensee with Appeal Rights and informed licensee that he has 15 days to appeal any decisions that were made by LPAs today, 10/21/2022.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Bardo Baluyot
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/21/2022 03:15 PM - It Cannot Be Edited


Created By: Bardo Baluyot On 10/21/2022 at 02:43 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MAYILYAN FAMILY CHILD CARE
FACILITY NUMBER: 198019932

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/21/2022
Section Cited
CCR
102418(a)

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(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

This requirement is not met as evidenced by:
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Licensee states that he will acquire current immunizations for all children enrolled by POC date of 11/4/2022
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 8 children's files did not have proper documents including immunizations records on file which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
10/21/2022
Section Cited
CCR102421(a)

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(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).
This requirement is not met as evidenced by:
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Per Licensee, children's files will be updated by POC date of 11/4/2022
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Based on file review and interview with Licensee, the licensee did not comply with the section cited above in 3 out of 11 children did not have files available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
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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:Ana Chico
LICENSING EVALUATOR NAME:Bardo Baluyot
LICENSING EVALUATOR SIGNATURE:
DATE: 10/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/21/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/21/2022 03:15 PM - It Cannot Be Edited


Created By: Bardo Baluyot On 10/21/2022 at 02:51 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MAYILYAN FAMILY CHILD CARE
FACILITY NUMBER: 198019932

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/21/2022
Section Cited
CCR
102417(g)(8)

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(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.


This requirement is not met as evidenced by:
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Per Licensee, facility roster will be updated by POC date.
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Based on observation, interview and record review, the licensee did not comply with the section cited above by not having an updated/ current facility roster available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
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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:Ana Chico
LICENSING EVALUATOR NAME:Bardo Baluyot
LICENSING EVALUATOR SIGNATURE:
DATE: 10/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/21/2022


LIC809 (FAS) - (06/04)
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