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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021096
Report Date: 07/17/2023
Date Signed: 07/17/2023 03:20:09 PM

Document Has Been Signed on 07/17/2023 03:20 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:SARGSYAN FAMILY CHILD CAREFACILITY NUMBER:
198021096
ADMINISTRATOR:OFELYA SARGSYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 406-0306
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 14DATE:
07/17/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Ofelya Sargsyan, LicenseeTIME COMPLETED:
03:30 PM
NARRATIVE
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CASE- MANAGEMENT INSPECTION CONDUCTED IN ARMENIAN
Licensing Program Analyst (LPA), Anomeh Eivazian, conducted an unannounced case- management inspection to the above facility on 07/17/23 at 11:35 am. Upon LPA's arrival to the facility at 11:35 AM, licensee, Ofelya Sargsyan was not present in the home. LPA met with Aram Sargsyan, licensee's husband/assistant who guided LPA on a tour of the facility. At 11:55 AM, licensee, Ofelya Sargsyan arrived to the facility who stated she stepped out to get milk for children. Upon LPA's arrival to the facility, there were total of 14 children present in the home, one being infant, 7 school age with licensee's husband/assistant. LPA observed four children were napping in the daycare bedroom, 7 children were napping in the living room, and three children were awake playing in the detached playroom in the backyard.
The licensee was observed not to be operating within the licensed capacity and is exceeding the required limitations during this inspection. On 07/17/23, from 11:35 AM to 11:55 AM there were total of 14 children present in the facility with Aram Sargsyan, licensee's husband/assistant only.

The following are being cited in accordance to Title 22 of the California Code of Regulations. Please refer to 809D for cited deficiencies.



LPA Eivazian informed licensee, Ofelya Sargsyn that this report dated 07/17/23 documents 1 Type A citation which shall be posted for 30 consecutive days as there is/are immediate risks to the health, safety, or personal rights of children in care.
Also, LPA Eivazian informed the licensee, Ofelya Sargsyan to provide a copy of this licensing report dated 07/17/23 that documents 1 Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
Exit interview conducted and report was reviewed with the Licensee, Ofelya Sargsyan at 3:30 p.m..
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 07/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2023
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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Document Has Been Signed on 07/17/2023 03:20 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 07/17/2023 at 01:06 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: SARGSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021096

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/18/2023
Section Cited

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Staffing Ratio and Capacity
The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.
This requirement was not met as evidenced by...
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On 07/17/23 from 11:35 AM to 11:55 AM, there were total of 14 children present in the home, one being infant, 7 school age with licensee's assistant only. At 11:55 AM licensee arrived to the facility. This poses an immediate health, safety and personal right to the children 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:Christina Gabelman
LICENSING EVALUATOR NAME:Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:
DATE: 07/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/17/2023


LIC809 (FAS) - (06/04)
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