Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406214343
Report Date: 03/04/2016
Date Signed 03/04/2016 12:58:53 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:SIMONIAN FCC AKA HOPE FAMILY CHILD CAREFACILITY NUMBER:
406214343
ADMINISTRATOR:ROBIN ROSE SIMONIANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 888-9504
CITY:PISMO BEACHSTATE: CAZIP CODE:
93449
CAPACITY:14CENSUS: 7DATE:
03/04/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Robin Rose SimonianTIME COMPLETED:
01:10 PM
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(3) Licensing Program Analyst (LPA) Maria Mueller conducted an annual random visit and met with licensee, Robin Simonian and her sister, Sophia Simonian. LPA observed 7 children in the home. The living room, dining room and 2 bedrooms for day care. The home is clean and organized. Fireplace is gated to prevent access by children. LPA observed age appropriate toys, games, books, tables and chairs. The outdoor play area is completely fenced, LPA observed age appropriate toys, shade and garden area. LPA observed a medium dog outdoors.

The fire extinguisher was serviced February 4, 2016. The smoke alarm/carbon monoxide detector was tested and was found operational. Safety drills were conducted and documented. The children's records reviewed, Immunization records were documented and updated on PM 286, Admission agreement reviewed, Identification and Emergency form. Licensee provided Notification of Parent's rights.

Licensee is current with CPR and First Aid which expires February 13, 2018.
Licensee stated that there are no guns or ammunition in the home. Licensee is not providing Incidental Medical Services.

Licensee was made aware that it is her responsibility to know the regulations for Family Child Care Home which can be accessed online at www.ccld.ca.gov.


Today, no deficiencies cited under Title 22 Division 12.


LPA observed licensee post the Notice of Site visit.
SUPERVISOR'S NAME: Deborah AjaoTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Maria MuellerTELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2016
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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