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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624204
Report Date: 08/10/2022
Date Signed: 08/10/2022 11:01:53 AM

Document Has Been Signed on 08/10/2022 11:01 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:
08/10/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Mariya SimonyanTIME COMPLETED:
11:15 AM
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At 10:35 a.m. on Wednesday, August 10th, 2022, Licensing Program Analyst (LPA) Karyn Guerra met with Applicant, Mariya Simonyan for the purpose of a prelicensing inspection. During today's inspection, LPA observed corrections to backyard fencing leading to the creek area. LPA observed mesh fencing tethered to the nearby wooden fencing. LPA also observed meshed fencing added beneath the gate doorway. Finally, LPA observed a self latching device added within 6 inches of the top of the gate. Applicant also provided proof of enrollment for EMSA certified Pediatric CPR course.

As of Wednesday, August 10th, 2022, facility is approved for a PROVISIONAL Small Family Child Care Home license for a capacity of 6 children with no more than 3 infants, or 4 infants only, or up to 8 children with no more than 2 infants, 1 child in Transitional Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2. Applicant understands that this license will expire in 90 days.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2022
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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