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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418057
Report Date: 02/07/2023
Date Signed: 02/07/2023 02:45:21 PM


Document Has Been Signed on 02/07/2023 02:45 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:MKHITARYAN FAMILY CHILD CAREFACILITY NUMBER:
197418057
ADMINISTRATOR:MKHITARYAN, MARIYETTAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 893-9447
CITY:VALLEY VILLAGESTATE: CAZIP CODE:
91607
CAPACITY:14CENSUS: 8DATE:
02/07/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:13 PM
MET WITH:MKHITARYAN, MARIYETTA- LicenseeTIME COMPLETED:
03:15 PM
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On 2/7/2023, Licensing Program Analyst (LPA) Suzette Ornelas conducted an unannounced Case Management Inspection for the purpose of temporarily updating the facility sketch due to construction of the backyard area (2/2023 through approximately 07/2023). LPA was greeted by Licensee, MKHITARYAN, MARIYETTA. Also present during the inspection was licensees two assistants who are associated to the facility. LPA observed 8 children present. The home was toured with the licensee to conduct a health and safety inspection. Hours of operation are Monday through Friday, 8am to 6pm.

This is a one-story home which consists of 2 bedrooms, 2 bathrooms, kitchen/dining room, living room, children's play area room, front yard and backyard. The isolation area will be in the living room.

The on-limit areas are as follows:children play area room, bathroom (located next to children's play area room), living room (for napping), hallway (when walking to and from the living room area and when leading the children to the front yard play area).
The off-limit areas are as follows: bedroom 1, bathroom 2, kitchen/dining room, laundry room (only when leading children to the backyard play area/to child care rooms) and backyard (designated area).

Off limits rooms are made inaccessible by the use of closed/locked doors and supervision. LPA obtained the following forms: City Permit Approval, Plan of Action, LIC279, LIC999A, signed plan of action for each child in care.

LPA observed the front yard play area for safety and did not observe any potential hazards. Front yard is gated with a latch located at the top of the gate which is inaccessible to children. There is shade, space, and enough toys for children to play. Children will not be in contact with construction area.

Exit Interview conducted, Notice of Site Visit Provided.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette OrnelasTELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2023
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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