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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494535
Report Date: 11/13/2023
Date Signed: 11/13/2023 03:55:51 PM

Document Has Been Signed on 11/13/2023 03:55 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:BADALYAN FAMILY CHILD CAREFACILITY NUMBER:
197494535
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
11/13/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Licensee, Anna Badalyan TIME COMPLETED:
03:15 PM
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On 11/13/2023, Licensing Program Analyst (LPA) Sarah Garcia conducted an unannounced case management inspection for the purpose of issuing a deficiency. LPA meet with licensee Anna Badalyan. Present during the time of inspection were (2) employees. During a case management capacity increase visit, LPA observed the employees that were not associated to the facility.

LPA observed the employee who were not associated to the facility, employee 1 (E1) and employee 2 (E2). LPA reviewed records and confirmed that the employees are cleared but not associated to the facility. Based on LPA observing the not associated employee(s), E1 and E2 in the home during a visit; interviews with E1, E2, licensee, all confirming E1 and E2 provided care for 3 days each. Additionally, LPA reviewed the personnel roster via Guardian which confirmed E1 and E2 were not associated with the facility. LPA observed E1 and E2 in the home during visit.

Per California Code of Regulations, Title 22, Division 12 & Chapter 1, the following deficiencies are being cited on the attached LIC 809D. The facility is issued a Type A citation and an immediate civil penalty of $600 is being assessed for the the not associated E1 and E2 at the facility.

Exit interview conducted and a copy of the report, appeal rights along with the Notice of Site Visit were provided
to licensee, Anna Badalyan.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Sarah Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 11/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/13/2023
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 11/13/2023 03:55 PM - It Cannot Be Edited


Created By: Sarah Garcia On 11/13/2023 at 03:05 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: BADALYAN FAMILY CHILD CARE
FACILITY NUMBER: 197494535

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/14/2023
Section Cited
CCR
102370(d)(1)

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102370 Criminal Record Clearance (d)(1) All individuals subject to a criminal record review pursuant to...shall prior to working, residing, or volunteering...Obtain a California clearance or a criminal record exemption...
This requirement is not met as evidenced by:
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 Licensee will associate E1 and E2 by 11/14/2023. Licensee wil provide proof of assocation facility roster to LPA email sarahgarcia@dss.ca.gov by 5pm on 11/14/2023.
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Based on observation, interviews, and record
review, the licensee did not associate Employee 1 (E1) and Employee (E2) to the facility address which poses an immediate health, safety, and personal rights risk to children 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:Maureen Neal
LICENSING EVALUATOR NAME:Sarah Garcia
LICENSING EVALUATOR SIGNATURE:
DATE: 11/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/13/2023


LIC809 (FAS) - (06/04)
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