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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624204
Report Date: 08/09/2022
Date Signed: 08/09/2022 10:22:39 AM

Document Has Been Signed on 08/09/2022 10:22 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:SIMONYAN, MARIYAFACILITY NUMBER:
343624204
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
08/09/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Mariya SimonyanTIME COMPLETED:
10:40 AM
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At 9:40 a.m. on Tuesday, August 9th, 2022, Licensing Program Analyst (LPA) Karyn Guerra met with Applicant, Mariya Simonyan, for the purpose of a prelicensing inspection. During today's inspection, LPA reviewed corrections to fencing for a body of water. There is a creek that runs through the backyard. Applicant added mesh wire fencing to the top portion of the fence on the left side so that the fencing is at least 5 ft tall. There is also a large fountain in front of the house. Fountain was drained of water. Applicant stated that fountain will remain without water. During today's inspection, LPA observed drain in the base of the fountain, and a secondary drain in the concrete outside of the fountain. LPA requested applicant run a hose in the fountain, and water drainage was observed.

The following corrections shall be made prior to licensure:

1. Applicant will register for an EMSA certified pediatric CPR course.
2. Mesh fencing will be tethered on the far left.
3. A self latching device shall be added not more than 6 inches from the top of the gate that leads to the creek area.
4. Fencing shall be added below the gate to minimize any openings leading to the creek area.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2022
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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