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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020974
Report Date: 11/14/2024
Date Signed: 11/14/2024 04:48:23 PM

Document Has Been Signed on 11/14/2024 04:48 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:ALEXANDY FAMILY CHILD CAREFACILITY NUMBER:
198020974
ADMINISTRATOR/
DIRECTOR:		TALIN ALEXANDYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 877-0607
CITY:LA CRESCENTASTATE: CAZIP CODE:
91214
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
11/14/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Licensee, Talin AlexandyTIME VISIT/
INSPECTION COMPLETED:
05:10 PM
NARRATIVE
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On November 14, 2024, at 1:50 PM Licensing Program Analysts (LPA) Priscilla Ochoa conducted an unannounced annual inspection at the above facility. LPA was greeted by licensee, Talin Alexandy and licensee’s husband. The licensee has 1 assistant who was also present during the inspection. All adults present during the inspection have criminal record clearance. Licensee only speaks Armenian. Licensee’s husband was translating for licensee during the inspection. There are 8 children enrolled and LPA observed 5 children in care. Hours of operation are Monday through Saturday form 8:00 AM to 5:30 PM. LPA provided a copy of Entrance Checklist—Family Childcare Home (LIC126) to licensee.

Family members residing in the home are 3 adults who have criminal record clearance. This is a single-story home that consists of 3 bedrooms, 2 restrooms, living room, dining room, kitchen, patio, front yard, back yard (fenced) and basement. Per licensee, parents enter the home through the main entrance which leads to the living room.

Areas accessible to children are living room (main daycare area), 1 bathroom that is located across from the dining room and backyard.

Off limit areas include 3 bedrooms, 1 bathroom, kitchen, dining area, basement, and front yard. Per licensee, children only walk through the dinning area when they are walked by an adult to the restroom.

At 2:00 pm, licensee guided LPA on a tour of the areas that are accessible to the children in care. Upon entrance from the front door, LPA observed children’s cubbies and parent board. Then LPA walked through to the living room area where age-appropriate toys and TV for children in care were observed. Napping equipment was observed to be clean and orderly. The area toured next was the dinning area. LPA observed a child gate in between the living room and dining area making the dining area inaccessible to children in care. In the dining area, LPA observed a dining table and chairs. Another child gate was observed between the dining area and kitchen, making the kitchen area inaccessible to children in care.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Priscilla Ochoa
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Page: 1 of 10
Document Has Been Signed on 11/14/2024 04:48 PM - It Cannot Be Edited


Created By: Priscilla Ochoa On 11/14/2024 at 03:41 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: ALEXANDY FAMILY CHILD CARE
FACILITY NUMBER: 198020974

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(a)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above as assistant does not have an employee file. File is missing LIC 9052 Emplyee Rights, LIC 9108 Statement Acknowledging Requirement to report child abuse which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/18/2024
Plan of Correction
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Licensee will create a staff file for assistant. Assistant will complete and sign LIC 9052 Emplyee Rights and LIC 9108 Statement Acknowledging Requirement to report child abuse and keep in file. Licensee will send proof for completed forms to LPA P. Ochoa by POC date of 11/18/2024
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above as proof of assistant's immunizations were not provided during inspection which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/06/2024
Plan of Correction
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Licensee will obtain proof that assistant is immunized against influenza, pertussis, measles, and TB. Licensee will send proof to LPA P. Ochoa by POC date of 12/06/2024 and keep in employee file.
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:Ana Chico
LICENSING EVALUATOR NAME:Priscilla Ochoa
LICENSING EVALUATOR SIGNATURE:
DATE: 11/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/14/2024


LIC809 (FAS) - (06/04)
Page: 2 of 10
Document Has Been Signed on 11/14/2024 04:48 PM - It Cannot Be Edited


Created By: Priscilla Ochoa On 11/14/2024 at 03:41 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: ALEXANDY FAMILY CHILD CARE
FACILITY NUMBER: 198020974

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above as licensee does not have a current roster for licensing to observe which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/18/2024
Plan of Correction
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Licensee will complete childcare roster and send copy to LPA P. Ochoa by POC date 11/18/2024
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Ana Chico
LICENSING EVALUATOR NAME:Priscilla Ochoa
LICENSING EVALUATOR SIGNATURE:
DATE: 11/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/14/2024


LIC809 (FAS) - (06/04)
Page: 3 of 10
Document Has Been Signed on 11/14/2024 04:48 PM - It Cannot Be Edited


Created By: Priscilla Ochoa On 11/14/2024 at 03:41 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: ALEXANDY FAMILY CHILD CARE
FACILITY NUMBER: 198020974

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102419(d)(1)
Admission Procedures and Authorized Representatives Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or
authorized representative has received and read the LIC 995A. The bottom portion of this form
must be kept in the child’s file as proof that the parent or authorized representative has been
notified of his or her rights and received a copy of the Caregiver background Check Process, LIC
995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above as 5 out of 5 children did not have LIC 995A and LIC 627 completed and signed by child representative which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/22/2024
Plan of Correction
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Licensee will have child representative complete and sign LIC 995A and LIC 627. Licensee will keep these forms in the child's file and send proof of completed forms to LPA P. Ochoa by POC date of 11/22/2024

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:Ana Chico
LICENSING EVALUATOR NAME:Priscilla Ochoa
LICENSING EVALUATOR SIGNATURE:
DATE: 11/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/14/2024


LIC809 (FAS) - (06/04)
Page: 4 of 10
Document Has Been Signed on 11/14/2024 04:48 PM - It Cannot Be Edited


Created By: Priscilla Ochoa On 11/14/2024 at 03:41 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: ALEXANDY FAMILY CHILD CARE
FACILITY NUMBER: 198020974

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above as sleep logs for infants were not available to be observed during inspection which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/22/2024
Plan of Correction
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Licensee will continue to monitor and document infant safe sleep every 15 minutes. Licensee will provide proof of sleep logs starting November 15th, 2024 to LPA P. Ochoa by POC date 11/22/2024
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Ana Chico
LICENSING EVALUATOR NAME:Priscilla Ochoa
LICENSING EVALUATOR SIGNATURE:
DATE: 11/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/14/2024


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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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ALEXANDY FAMILY CHILD CARE
FACILITY NUMBER: 198020974
VISIT DATE: 11/14/2024
NARRATIVE
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 LPA then inspected the children’s bathroom which is located in the hallway across from the dining room. LPA did observe a hair cut machine in the bathroom vanity cabinet. LPA observed licensee’s husband remove the haircut machine from the restroom. LPA then toured the backyard which a child gate was observed between the patio and backyard. In the backyard LPA observe multiple age-appropriate toys for children in care. LPA also observed a shed that is always locked with lock and key, making it inaccessible to children in care. All areas were observed to be clean, orderly, comfortable, and well ventilated.

There are first aid supplies available. Per licensee, the facility provides all meals and snacks to daycare children.

Licensee's poisons, detergent, cleaning compounds, medications and other items which could pose a danger to child are stored where they are inaccessible to children.

LPA observed smoke/Carbon Monoxide detector in the hallway next to the restroom. LPA did not test detector as children were napping in the living room area. A 2A-10BC fire extinguisher was observed and serviced on 03/18/2024. There is a working telephone on site.

Per the licensee, there are no firearms or pets on the premises. Licensee obtained current Pediatric First Aid and CPR certification expires on 3/2026.

LPA conducted a children file review and found not complete. 5 out of 5 children were missing LIC 627, Consent for Emergency Medical Treatment and LIC 995A, Notification of Parent’s Rights. LPA provided a copy of these forms for licensee to ensure parents complete the form and licensee keeps in child files. LPA was unable to observe 4 of 5 children’s sleep log where licensee documents safe sleep every 15 minutes. Per licensee, they were unaware they had to keep sleeps logs. Previous sleep logs have been discarded. LPA explained the safe sleep regulation to licensee. LPA did not review assistant file as files was unavailable during inspection. Licensee will need to be created a staff file for assistant with all the necessary documents and send proof of completed file to LPA. Children and staff names were documented. A child roster was not observed as licensee was unaware, they had to complete.

Licensee has completed Mandated Reporter training as it expires on 4/07/2026. All childcare employees must complete mandated reporter training within 30 days of hire and renew training every two years at www.mandatedreporterca.com

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Priscilla Ochoa
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
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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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ALEXANDY FAMILY CHILD CARE
FACILITY NUMBER: 198020974
VISIT DATE: 11/14/2024
NARRATIVE
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Per the licensee, fire and disaster drills are conducted every 6 months; last drill documented and conducted on 10/25/2024.

Licensee has the required documents posted in the FCCH; Facility License (LIC 203), Emergency Disaster Plan (LIC610a), Notification of Parents' Rights Poster (PUB 394).

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B. The on Duty Worker is available for questions Monday through Friday at (323) 981-3350 from 8:00 AM - 5:00 PM.

The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000. Also call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).

The licensee was informed that the presence of adults in the home without Criminal Record Clearance or Exemption will be cited and civil penalty assessed for $100 per day. The licensee may find additional information and forms on the DSS website at www.ccld.ca.gov including information on the Live Scan application (LIC 9163). Appointments can be made for Live Scan at 1-800-315-4507

The following was discussed with the licensee:


Capacity requirements, Roster requirements, Posting requirements, Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children’s files and provider’s files, and Safe Sleep Awareness. The role and responsibilities of being a mandated reporter were reviewed. Licensee was reminded that supervision is always required to children in care.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Priscilla Ochoa
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ALEXANDY FAMILY CHILD CARE
FACILITY NUMBER: 198020974
VISIT DATE: 11/14/2024
NARRATIVE
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Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility’s phone number; if the phone number is changed, licensing must be notified.

Regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.

--Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.


-- Our Quarterly updates come out every 3 months they are also now in Spanish please log in to the CCLD website or you can email our advocates to have the quarterly updates send directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee [or 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.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

The licensee, licensee, Talin Alexandy and licensee’s husband confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

LPA provided consultation during inspection.



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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Priscilla Ochoa
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC809 (FAS) - (06/04)
Page: 9 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ALEXANDY FAMILY CHILD CARE
FACILITY NUMBER: 198020974
VISIT DATE: 11/14/2024
NARRATIVE
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Based on the LPA’s observations and record review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety.

A notice of site visit was given and must remain posted for 30 days during facility’s hours of operation. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and a copy of the report was provided, along with appeal rights to licensee, Talin Alexandy and licensee’s husband.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Priscilla Ochoa
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC809 (FAS) - (06/04)
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