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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624204
Report Date: 02/05/2024
Date Signed: 02/05/2024 10:29:33 AM

Document Has Been Signed on 02/05/2024 10:29 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SIMONYAN, MARIYAFACILITY NUMBER:
343624204
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
02/05/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Mariya SimonyanTIME COMPLETED:
10:45 AM
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Licensing Program Manager (LPM) Natalie Dunaway and Licensing Program Analyst (LPA) Stephanie Piring met with Licensee Mariya Simonyan and Joseph Simon , for the purpose of an informal facility visit.

LPM defined the difference between non-compliance and an informal meeting. LPM advised that the purpose of today's meeting is to help the facility gain compliance.

Today's informal meeting was to discuss the Type A citation issued on 01/29/2024 during a case management inspection.

On 01/29/2024 the facility was cited a type A citation regarding accessible bodies of water.

The Licensee stated that they have taken the following steps to maintain compliance:

1. The fountain was immediately drained so that it is and will remain free of water.
2. A plug was placed over the faucet to prevent filling the fountain with water.
3. Licensee understands that the fountain cannot have water in it, standing water or flowing water, at any time.

Prior to granting request for capacity increase licensee will add approximately 1 foot of additional fencing adjacent to the left of the gate.


Exit interview and report reviewed with Licensee, Mariya Simonyan. Notice of Site provided and must remain posted for 30 days.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Stephanie Piring
LICENSING EVALUATOR SIGNATURE: DATE: 02/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/05/2024
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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