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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020572
Report Date: 08/18/2023
Date Signed: 08/18/2023 02:53:01 PM

Document Has Been Signed on 08/18/2023 02:53 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:ASRYAN FAMILY CHILD CAREFACILITY NUMBER:
198020572
ADMINISTRATOR:NARINE ASRYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 334-7805
CITY:GLENDALESTATE: CAZIP CODE:
91201
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 8DATE:
08/18/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Narine Asryan, LicesneeTIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA), Anomeh Eivazian, conducted an unannounced case- management inspection to the above facility on 08/18/23 at 1:30 p.m.. LPA met with Narine Asryan, licensee who guided LPA on a tour of the facility. During this inspection Mariam Tonoyan, Licensee's assistant was also present. During this inspection there were total of 8 children present in the facility.

Per licensee, Narine Asryan on 08/09/23 a Police officer showed up at the facility due to a call that Glendale Police Department received from parent#1 that licensee, Narine Asryan did not release child#1 to parent#1.

Licensee did not notify the Department when Police Officer from Glendale Police Department visited the facility on 08/09/23 during operation hours.



The following are being cited in accordance to Title 22 of the California Code of Regulations. Please refer to 809D for cited deficiencies.


The Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.

Exit interview conducted with Narine Asryan, licensee at 3:00 p.m..
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 08/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2023
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 08/18/2023 02:53 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 08/18/2023 at 01:06 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: ASRYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020572

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/25/2023
Section Cited
CCR
102416.2(b)(3)(c)

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The licensee shall report to the Department any…unusual incidents or child absence that threatens the physical or emotional health or safety of any child.
This requirement was not met as evidenced by:
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Per Licensee, licensee will submit an LIC624B unusual incident report for when Glendale Police Department visited her facility during operation hours. Licensee will also watch video at ccld.childcarevideos.org on Reporting Requirements and submit a summary by POC date 08/25/23.
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Based on licensee's interview, Licensee did not notify the Department when Police Officer from Glendale Police Department visited the facility on 08/09/23 during operation hours. This poses a potential risk to the health, safety, and personal rights of 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:Christina Gabelman
LICENSING EVALUATOR NAME:Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:
DATE: 08/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2023


LIC809 (FAS) - (06/04)
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