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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017772
Report Date: 08/01/2023
Date Signed: 08/01/2023 12:46:31 PM

Document Has Been Signed on 08/01/2023 12:46 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:CHILINGARYAN FAMILY CHILD CAREFACILITY NUMBER:
198017772
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 6DATE:
08/01/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Gayane Chilingaryan, LicenseeTIME COMPLETED:
01:00 PM
NARRATIVE
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PLAN OF CORRECTION INSPECTION CONDUCTED IN ARMENIAN

Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced plan of correction inspection to the above facility on 08/01/2023 to ensure the Type A and Type B deficiencies cited on 07/24/2023 have been cleared. LPA arrived at the facility at 11:00 AM and met with Gayane Chilingaryan, Licensee who guided analyst on a tour of the facility. A COVID 19 risk assessment was conducted prior to entering the facility.

During this inspection there were 6 children present in the facility with licensee, four being infants and two children age between 2-3 years old. The licensee was observed not to be operating within the licensed capacity and is exceeding the required limitations during this inspection which poses an immediate health, safety and personal right to children in care.

LPA informed licensee the maximum number of children that she can provide care to is as follow:
Capacity 6: no more than 3 infants or 4 infants only. Capacity 8: no more than 2 infants, 1 child in kindergarten or elementary school and 1 child at least age 6.

The following has been observed:
1. Licensee has a working telephone services in the home via cellphone which will stay in the home during facility operation hours.
2. LPA observed Individual Infant Sleep Plan form LIC 9227 in four infants files.
3. LPA reviewed Infant Nap Chart for current four infants and it was completed and current.
4. Licensee submitted current facility roster and it was updated.
REPORT CONTINUES ON NEXT PAGE 1 of 2
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CHILINGARYAN FAMILY CHILD CARE
FACILITY NUMBER: 198017772
VISIT DATE: 08/01/2023
NARRATIVE
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The Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

LPA Eivazian informed licensee, Gayane Chilingaryan that this report dated 08/01/23 documents 1 of Type A citation Type A citation which shall be posted for 30 consecutive days as there is/are immediate risks to the health, safety, or personal rights of children in care.

Also, LPA Eivazian informed the licensee, Gayane Chilingaryan to provide a copy of this licensing report dated 08/01/23 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardian for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the Licensee, Gayane Chilingaryan at 1:00 PM.


REPORT END 2 of 2
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/01/2023 12:46 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 08/01/2023 at 12:09 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CHILINGARYAN FAMILY CHILD CARE
FACILITY NUMBER: 198017772

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/02/2023
Section Cited
CCR
102416.5(a)

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 The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.

This requirement is not met as evidenced by:
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Per licensee, she was in impression that she needs to drop off one child.
Per licensee, she will review her roster and will decide if she want to provide care to only 4 infants or capacity of 6 with three infants.
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Based on LPA's observation on 08/01/23 the licensee was operating out of ratio, there were total of 6 children present in the facility, 4 being infants and 2 children being 2-3 years old, which poses an immediate health, safety or personal rights risk to persons in care.
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A written plan will be submitted to LPA by 08/02/23.

$250 Civil Penalty was issued on this date for repeated violation.

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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:Christina Gabelman
LICENSING EVALUATOR NAME:Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2023


LIC809 (FAS) - (06/04)
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