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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417697
Report Date: 04/05/2022
Date Signed: 04/05/2022 02:48:41 PM

Document Has Been Signed on 04/05/2022 02:48 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:AKCHEIRLIAN FAMILY CHILD CAREFACILITY NUMBER:
197417697
ADMINISTRATOR:AKCHEIRLIAN, ANIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 288-2272
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
04/05/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:38 PM
MET WITH:Assitant: Staff 2TIME COMPLETED:
03:00 PM
NARRATIVE
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On 4/5/22 at 12:57 p.m., Licensing Program Analysts (LPA) Antonio Almanza were at the licensed facility conducting an alternate inspection when the deficiencies listed below were observed. LPA met with Assistant #1 and explained the purpose of the visit. LPA observed 5 children and two adults providing care and supervision to children in care. Licensee AKCHEIRLIAN, ANI was not present during the initial visit and arrived at 1:47 pm with three school age children.

Deficiencies observed:
At 1:07 PM licensee's assistant (Staff #2) was observed by LPA providing care to day care children without a criminal record clearance. After obtaining statements from facility staff members and licensee, it was determined that Staff #2 has been in the facility for 7 days. This will result in a Type A citation, see LIC809-D. A civil penalty will also be issued, see LIC421BG

At 1:16 PM LPA observed 1 bottles of cleaning supplies under the bathroom sink, one bottle of Clorox spray and one bottle of disinfecting spray on top of bathroom sink counter top and a febris aerosol spray on top of toilet.This will result in a Type A citation, see LIC809-D.

Two Type A deficiencies are being cited during today's inspection (see LIC 809Ds). Each report (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit (printed out during this inspection).

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SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE: DATE: 04/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/05/2022
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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Document Has Been Signed on 04/05/2022 02:48 PM - It Cannot Be Edited


Created By: Antonio Almanza On 04/05/2022 at 01:49 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: AKCHEIRLIAN FAMILY CHILD CARE
FACILITY NUMBER: 197417697

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/05/2022
Section Cited
CCR
102370(d)(1)

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102370(d)(1) Criminal Record Clearance(d) All individuals subject to a criminal record review... shall prior to working, residing, or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department.
This Requirement is not met as evidenced by:
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Licensee will comply with regulations and not allow Staff 2 to return until she has received a criminal record Clearance and is associated to the facility.
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Based on observation, interview and record review, The Licensee did not make sure that Staff 2 has a criminal record clearance prior to working or volunteering in Licensed facility, which poses an immediate Health and Safety, and personal rights risk to persons in care.
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Type A
04/05/2022
Section Cited
CCR102417(g)(4)

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102417(g)(4) Operation of a Family Child Care Home: Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
This Requirement is not met as evidenced by:
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Licensee has removed all Poisons, detergents, cleaning compounds from under the bathroon sink and top
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Based on observation, The Licensee did not make Poisons, detergents, cleaning compounds inaccessible to children under the bathroon, drawer, and ontop of bathroom sink, which poses an immediate Health and Safety, and personal rights risk to persons 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:Mary Ruiz
LICENSING EVALUATOR NAME:Antonio Almanza
LICENSING EVALUATOR SIGNATURE:
DATE: 04/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/05/2022


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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: AKCHEIRLIAN FAMILY CHILD CARE
FACILITY NUMBER: 197417697
VISIT DATE: 04/05/2022
NARRATIVE
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**In addition; A copy of this report must be provided to the authorized representatives of all currently enrolled children and any newly enrolled child for the following 12 months.
The LIC9224 ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (was provided to the licensee) shall be signed and kept in each of the children’s records. The report shall be provided no later than the next business day or the next day the child is in care.

A copy of this report, notice of site visit, Appeal Rights (LIC 9058), were given and explained to the Licensee AKCHEIRLIAN, ANI.

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SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2022
LIC809 (FAS) - (06/04)
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