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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
197494894
Report Date:
12/07/2022
Date Signed:
12/07/2022 03:10:42 PM
Document Has Been Signed on
12/07/2022 03:10 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:
MELKONYAN & HOVHANNISYAN FAMILY CHILDCARE
FACILITY NUMBER:
197494894
ADMINISTRATOR:
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
CITY:
STATE:
ZIP CODE:
CAPACITY:
8
TOTAL ENROLLED CHILDREN:
6
CENSUS:
5
DATE:
12/07/2022
TYPE OF VISIT:
Annual/Random
UNANNOUNCED
TIME BEGAN:
08:34 AM
MET WITH:
TIME COMPLETED:
12:30 PM
NARRATIVE
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On 12/07/2022, at 8:34 AM, Licensing Program Analyst (LPA), conducted an unannounced Annual Required Inspection and was met by Licensee, Ghevond Melkonyan. Also present were Co-Licensee and Staff #1 (S1). Days and hours of operation are Monday through Friday from 7:00 AM to 6:00 PM. LPA verified facility phone number (Cell phone) is 818-926-8619; Licensee was reminded that when there are children in care the cell phone must remain in the facility. During today’s visit there were 5 children in care. Co-Licensees and 2 minor children ages 3 and 8 years old live in the home.
The Family Child Care home is located on the corner of Oakdale Ave and Strathern St. The home is entered on Strathern St. The home has a security gate with ring doorbell and visitors must be allowed inside by the Licensee. The home is a 5 bedroom 3 ½ bathroom, with detached garage. The rooms used for Children in care are located in the back of the home and are identified as Rooms 1, Room 2 and Room 3 on the facility Sketch. The Rooms 1 & 2 are used for activities and Room 3 is used for sleeping.
Current facility sketch was reviewed, and Licensee confirmed that Rooms 1, 2, 3 and bathroom inside Room 2 are used for providing care and supervision to children in care. All other rooms are off-limits and made inaccessible by use of child safety locks and child safety gate. Licensee failed to notify Licensing of the addition of a laundry room next to the bathroom used by children in Room #2. There is a firearm and ammunition on the premises. Firearms and ammunition are stored and locked in a safe, located in the closet of the Licensees bedroom. All poisons are kept in a locked storage area inaccessible to children in care. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible to children in care.
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SUPERVISORS NAME
:
Betty Bell
LICENSING EVALUATOR NAME
:
Antonio Almanza
LICENSING EVALUATOR SIGNATURE
:
DATE:
12/07/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/07/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH
,
300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO
,
CA
90245
FACILITY NAME:
MELKONYAN & HOVHANNISYAN FAMILY CHILDCARE
FACILITY NUMBER:
197494894
VISIT DATE:
12/07/2022
NARRATIVE
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There are no fireplaces or open face heaters in the home. There is a fire extinguisher located in the pantry next to room one (LPA is unable to verify when it was purchased or serviced within one year. There are working combination smoke detector/carbon monoxide detector located in the Laundry room inside of room 2, and kitchen. The home has central air to provide adequate heating and ventilation for safety and comfort. There are no stairs in this home. At 9:08 AM, LPA observed Child 2 in a bouncer, Licensee was provided Prohibited Items In Child Care Homes Flyer.
There is currently one infants in care (Child 2/C2). LPA discussed Safe Sleep Regulations with licensee. There is one crib or play yard for each infant in care, cribs and play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants shall not swaddled while in care. Provider was advised that staff shall physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants shall be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan shall be completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.
C2 does not have documentation showing that C2 is checked on every 15 minutes when sleeping and LIC 9227 Infant Sleeping plan on file. Licensee was provided Safe Sleep PIN 20-24-CCP.
Licensee was informed that children must be supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backyard is fenced and there are no hazards to children present. There is a large tree that provides shade to children. There is artificial turf in the backyard. There is large dog in the home that is maintained in areas that are not accessible to children in care. Capacity as specified on the license is being maintained.
LPA reviewed a sample of children’s files and observed files for Child 3 and Child 5 were not complete with emergency information as required. Licensee’s Mandated Reporter Training was completed on 08/17/2021.
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SUPERVISORS NAME
:
Betty Bell
LICENSING EVALUATOR NAME
:
Antonio Almanza
LICENSING EVALUATOR SIGNATURE
:
DATE:
12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/07/2022
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
EL SEGUNDO CC NORTH
,
300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO
,
CA
90245
FACILITY NAME:
MELKONYAN & HOVHANNISYAN FAMILY CHILDCARE
FACILITY NUMBER:
197494894
VISIT DATE:
12/07/2022
NARRATIVE
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Licensee’s pediatric CPR/First Aid expires on 08/16/2023. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles. Staff 1 does not have a criminal record clearance or exemption on file and is not associated to the Family Child Care Home.
Incidental Medical Services (IMS) are currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link
https://www.ada.gov/childqanda.htm
.
To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to
inspectionprocess@dss.ca.gov
. For additional information regarding the inspection and its tools and methods, please visit the
Program website
at
www.cdss.ca.gov/inforesources/community-care-licensing/process
.
Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
LPA discussed the safe sleep regulations with licensee [or facility and discussed the Child Care Licensing Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep
as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at
https://www.cpsc.gov/
and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
Pg 3 of 9
SUPERVISORS NAME
:
Betty Bell
LICENSING EVALUATOR NAME
:
Antonio Almanza
LICENSING EVALUATOR SIGNATURE
:
DATE:
12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/07/2022
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
EL SEGUNDO CC NORTH
,
300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO
,
CA
90245
FACILITY NAME:
MELKONYAN & HOVHANNISYAN FAMILY CHILDCARE
FACILITY NUMBER:
197494894
VISIT DATE:
12/07/2022
NARRATIVE
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Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiencies are being cited: 3 Type A and 6 Type B Violations (see next page, 809 D) Licensee was provided a copy of appeal rights.
A notice of site visit was given and must remain posted for 30 days.
**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 ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC9224) 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, and Appeal Rights were explained and provided to Licensee, GHEVOND MELKONYAN.
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SUPERVISORS NAME
:
Betty Bell
LICENSING EVALUATOR NAME
:
Antonio Almanza
LICENSING EVALUATOR SIGNATURE
:
DATE:
12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/07/2022
LIC809
(FAS) - (06/04)
Page:
3
of
9
Document Has Been Signed on
12/07/2022 03:10 PM
- It Cannot Be Edited
Created By:
Antonio Almanza
On
12/07/2022
at
01:43 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:
MELKONYAN & HOVHANNISYAN FAMILY CHILDCARE
FACILITY NUMBER:
197494894
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
12/07/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(d)(1)
Operation of A Family Child Care Home
(d) The home shall provide safe toys, play equipment and materials. (1) Fixtures, furniture, and equipment that have been banned or recalled by the United States Consumer Product Safety Commission shall not be used for children in care or accessible to children in care.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in that LPA observed Child 2 in a bouncer, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date:
12/07/2022
Plan of Correction
1
2
3
4
Licensee has removed bouncer from FCCH and will not allow it in the Licensed Family Child Care Home.
Type A
Section Cited
CCR
102417(g)(4)(C)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) 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. (C) Ammunition shall be stored and locked separately from firearms.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above in that there was a loaded firearm and 2 boxes of ammunition in locked safe, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date:
12/07/2022
Plan of Correction
1
2
3
4
Licensee removed the ammunition from the fire arm and ammunition from safe and stored separate from firearm.
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:
Betty Bell
LICENSING EVALUATOR NAME:
Antonio Almanza
LICENSING EVALUATOR SIGNATURE:
DATE:
12/07/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/07/2022
LIC809
(FAS) - (06/04)
Page:
5
of
9
Document Has Been Signed on
12/07/2022 03:10 PM
- It Cannot Be Edited
Created By:
Antonio Almanza
On
12/07/2022
at
01:43 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:
MELKONYAN & HOVHANNISYAN FAMILY CHILDCARE
FACILITY NUMBER:
197494894
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
12/07/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)(1)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 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 or
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview and record review, the licensee did not comply with the section cited above in that Staff 1 has been at the facility for 6 months and does not have a criminal record clearance on file and is not associated to the facility, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date:
12/07/2022
Plan of Correction
1
2
3
4
Staff 2 will not be allowed to return to the Facility until she has revceived a criminal record clearance and/or is asociated to the facility.
Section Cited
General Provisions and Definitions
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:
Betty Bell
LICENSING EVALUATOR NAME:
Antonio Almanza
LICENSING EVALUATOR SIGNATURE:
DATE:
12/07/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/07/2022
LIC809
(FAS) - (06/04)
Page:
6
of
9
Document Has Been Signed on
12/07/2022 03:10 PM
- It Cannot Be Edited
Created By:
Antonio Almanza
On
12/07/2022
at
01:43 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:
MELKONYAN & HOVHANNISYAN FAMILY CHILDCARE
FACILITY NUMBER:
197494894
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
12/07/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, record review, the licensee did not comply with the section cited above in that emergency/fire drill have not been completed, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
12/12/2022
Plan of Correction
1
2
3
4
Licensee will complete emergency/fire drill and provide LPA a copy by 12/12/22
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview and record review, the licensee did not comply with the section cited above in that Child 1 does not have documented 15 minute checks, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
12/08/2022
Plan of Correction
1
2
3
4
Licensee will create a log for 15 minute checks and provide LPA of copy for infants sleeping log for C2hild 2.
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:
Betty Bell
LICENSING EVALUATOR NAME:
Antonio Almanza
LICENSING EVALUATOR SIGNATURE:
DATE:
12/07/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/07/2022
LIC809
(FAS) - (06/04)
Page:
7
of
9
Document Has Been Signed on
12/07/2022 03:10 PM
- It Cannot Be Edited
Created By:
Antonio Almanza
On
12/07/2022
at
01:43 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:
MELKONYAN & HOVHANNISYAN FAMILY CHILDCARE
FACILITY NUMBER:
197494894
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
12/07/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(a)(10)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information: (10) A signed and dated copy of the Notice of Employee Rights [LIC 9052, (Rev. 03/03)] as required by Section 102416(a) and Section 102417.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in that Staff 1 does not have Notice of Employee Rights on file, which poses/posed a potential, health, safety or personal rights risk to persons in care.
POC Due Date:
12/12/2022
Plan of Correction
1
2
3
4
Licensee will provide Staff 1 with Notice of Employee Rights and email copy to LPA by 12/12/22.
Type B
Section Cited
CCR
102416.3(a)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following:
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview and record review, the licensee did not comply with the section cited above in that a washer machine room was built in the facility without notifying Licensing, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
12/07/2022
Plan of Correction
1
2
3
4
Licensee will provide LPA an updated facility sketch by 12/12/22.
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:
Betty Bell
LICENSING EVALUATOR NAME:
Antonio Almanza
LICENSING EVALUATOR SIGNATURE:
DATE:
12/07/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/07/2022
LIC809
(FAS) - (06/04)
Page:
8
of
9
Document Has Been Signed on
12/07/2022 03:10 PM
- It Cannot Be Edited
Created By:
Antonio Almanza
On
12/07/2022
at
01:43 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:
MELKONYAN & HOVHANNISYAN FAMILY CHILDCARE
FACILITY NUMBER:
197494894
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
12/07/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in that C3 & C5 do not have Identification and Emergency Infomration of file, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
12/12/2022
Plan of Correction
1
2
3
4
Licensee will have paretents of C3 and C5 complete LIC 700 and provide LPA a copy by email.
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in that Child 2 does not have LIC9227 on file, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
12/12/2022
Plan of Correction
1
2
3
4
Licensee will have paretns complete LIC9227 and provide LPA a copy via email.
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:
Betty Bell
LICENSING EVALUATOR NAME:
Antonio Almanza
LICENSING EVALUATOR SIGNATURE:
DATE:
12/07/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/07/2022
LIC809
(FAS) - (06/04)
Page:
9
of
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