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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700561
Report Date: 09/15/2022
Date Signed: 09/15/2022 02:57:29 PM

Document Has Been Signed on 09/15/2022 02:57 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:BOYAJYAN FAMILY CHILD CAREFACILITY NUMBER:
197700561
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
09/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Mariam BoyajyanTIME COMPLETED:
03:11 PM
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On 09/15/22 Licensing Program Analyst (LPA) Justin Dorsey, met with Licensee, Mariam Boyajyan for a Case Management - Other inspection.

During the inspection the following was observed:
  • LPA Dorsey observed one infant sleeping in cribs with blankets and stuffed animals. LPA observed that the blankets were removed form the infants cribs.
  • LPA Dorsey observed that the bedroom a infant was sleeping in had a closed door.
  • Licensee was unable to provide an infant sleep log for a infant in care. Per licensee she does conduct 15 minute checks but does not document the checks. LPA Dorsey emailed licensee a copy of the infant sleep log.

LPA Dorsey issued a Technical Violations and went over and emailed a copy of Safe Sleep PIN 20-24-CCP and infant sleep log to the licensee. An exit interview was conducted, a copy of this report was read and provided to Assistant Hakob Boyajyan due to the licensee conducting children pick-ups. Due to technical difficulties this report, appeal rights and notice of site visit was emailed to the licensee.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2022
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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