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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021151
Report Date: 01/17/2025
Date Signed: 01/17/2025 11:34:03 AM

Document Has Been Signed on 01/17/2025 11:34 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:SIMONYAN FAMILY CHILD CAREFACILITY NUMBER:
198021151
ADMINISTRATOR/
DIRECTOR:		SIMONYAN, KARINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 942-4470
CITY:GLENDALESTATE: CAZIP CODE:
91203
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
01/17/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Karine SimonyanTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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 Annual Inspection was conducted in Armenian.
On 01/17/25, at 09:30 am, Licensing Program Analyst (LPA) Shushanik Safaryan conducted an annual random inspection to the above facility. LPA met with Licensee, Karine Simonyan , to whom the reason for the visit was explained. Per Licensee, there are 11 children currently enrolled. There were 7 children present upon arrival. Licensee`s assistant Marina Pogosyan came in later .The licensee was observed to be operating within the license capacity limitations.

The licensee states that only one adult live in the home. All adults living in the home have obtained a criminal record clearance.

This is a duplex house, 423-425 West Lexington Drive, Glendale, CA 91203. Both addresses are owned by licensee, Karine Simonyan. A copy of Deed on file. Per licensee, both addresses are occupied by licensee's family.
Facility is a one-story duplex home located on the first level. The home consists of 1 bedroom, 1 restroom, living room (main day care area), kitchen, laundry room, detached garage, front yard, back yard (fenced). There is a door in the backyard which leads to the 425 W. Lexington Drive, Glendale, CA 91203. Per licensee, parents enter the home through the main entrance which leads to the living room (main daycare area).
During this visit, all areas identified that are accessible for children to use were inspected for the safety, comfort, and cleanliness. At 10:00 am , Licensee guided LPA to the tour of the home. LPA was toured starting from the living room, where LPA observed children tables , chairs , toys, TV. LPA observed child safety gate separating living room from other areas of the house . Next LPA toured the bathroom in the hallway and did not observe any hazards . In the hallway LPA observed child safety gate separating kitchen. Per licensee gate is closed during the day care hours . Next LPA toured the bedroom and observed 4 cribs . In the closet , LPA observed cots for napping .
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2025
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SIMONYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021151
VISIT DATE: 01/17/2025
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Per licensee infants sleeps in the crib in the bedroom and older children sleep in the living room . Per licensee there is always someone in the room with an infant and door is always open .
Facility License, Emergency Disaster Plan, Parent’s Rights Poster, and Earthquake Preparedness Checklist were observed to be posted in the living room.

There is telephone service via a cellphone and landline that stays at the facility during operation hours. Hours of operation are Monday – Friday, 08:30 am – 09:00 pm. There is central air and heating in the home.

Detergents, cleaning compounds, and medications were observed to be inaccessible to children. Per Licensee, there are no poisons in the home. LPA advised that any poisons should be locked under key or combination lock. Licensee states that there are no firearms or weapons stored in the home.

At 10:00 am , LPA observed required Fire extinguisher in the laundry room .The valve on the required 2A 10BC fire extinguisher indicates fully charged and LPA observed tag with the service date 07/19/2022. Smoke and carbon monoxide detectors were tested and are operable.

All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. Last drill documented was conducted on 11/2024.

The home is observed to be clean and orderly. There are first aid supplies available in the living room . There are age-appropriate toys available for children.

Per licensee, she provides food for children in care. Licensee was advised that if food is brought from the children’s homes, all containers must be labeled with child’s name and properly stored or refrigerated.
Currently, children are using the backyard for outdoor play time. To go to the back yard children, pass through laundry room . Per licensee supervision is always provided . The outdoor play area was observed to be fenced and gated. LPA observed separate gated area . Per licensee only that area is used by the children , no other areas of the back yard are used for day care . LPA observed toys and other materials for children to play. LPA observed green carpet in the gated area. LPA did not observe any objects that can pose danger to children. No bodies of water were observed on this day.
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2025
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SIMONYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021151
VISIT DATE: 01/17/2025
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At 10:30 am Licensee and staff records were reviewed. The licensee has completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 05/2026.
At 10:37 am, LPA observed that Licensees assistants missing proof of immunization. Two out of two missing proof of measles immunization and one of two missing proof of pertussis immunization .
At 11:00 am children’s records were reviewed, including emergency information, and were observed to be complete. Licensee states she is currently caring for only one infant over 12 months .

LPA created an LIC 857, Children’s Record Review, and LIC 859, Staff Record Review which documents staff and children’s files reviewed during this inspection.

Per licensee, there are no animals on the premises. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.
LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, and/or any other item that fall into these categories are not permitted in a family childcare facility.

Per licensee no children enrolled that need IMS services . 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.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2025
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SIMONYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021151
VISIT DATE: 01/17/2025
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LPA discussed the safe sleep regulations with licensee and 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.

LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing website at www.ccld.ca.gov.

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

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

Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.



LPA discussed all the deficiencies cited during today’s inspection with the licensee. Per licensee, she understands all the deficiencies and plan of correction .

A notice of site visit 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 Karine Simonyan on 01/17/2025.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/17/2025 11:34 AM - It Cannot Be Edited


Created By: Shushanik Safaryan On 01/17/2025 at 11:06 AM
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: SIMONYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021151

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/17/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations , interview and records review , the licensee did not comply with the section cited above. Fire extinguisher in the home had a service tag with the date indicating 07/19/2022, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/31/2025
Plan of Correction
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Licesee stated she will call the company to service Fire extinguisher or purchase new one .
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review aand interview ,the licensee did not comply with the section cited above. Two out of two assistants were missing proof of measles immunization, one out of two were missing pertusis immunization, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/31/2025
Plan of Correction
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Licnesee stated hae will obtain proof of immunization from assistants and will email proof to LPA by POC date .
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:Brandi VanOosten
LICENSING EVALUATOR NAME:Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:
DATE: 01/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/17/2025


LIC809 (FAS) - (06/04)
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