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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494185
Report Date: 05/12/2021
Date Signed: 05/14/2021 11:26:10 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:MIKAYELYAN FAMILY CHILD CAREFACILITY NUMBER:
197494185
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
05/12/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Applicant - Sona MikayelyanTIME COMPLETED:
11:20 AM
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On 05/14/2021 at 11:00am Licensing Program Analyst (LPA) Ericka Hill contacted the Applicant to conduct a Pre-Licensing inspection for a Large Family Child Care License. The visit was conducted by tele-visit communications due to COVID-19 restrictions. LPA Hill observed the accessible and inaccessible areas of the home.

Indoor areas:
Accessible: Front living room/child care area, Kitchen, Bedroom #1, and Bathroom #1. During the visit, LPA observed the front living room/child care area, Kitchen, Bedroom #1, and Bathroom #1 to be equipped with age-appropriate toys, materials, and equipment for daycare children. LPA did not observe any hazardous materials accessible to the children within these child care areas. LPA observed the accessible areas to be clean, free of hazardous items, and providing age-appropriate materials.

LPA observed the required documents on the Parent Board, fully serviced Fire extinguisher, working smoke detectors, and stocked First-Aid kit.

Inaccessible: Laundry room, Bedroom #2, and Bathroom #2. LPA observed these areas to be clean, free of hazardous items, and inaccessible to the children in care.

Outdoor Area:
LPA Hill observed age-appropriate toys, materials, and equipment for the children in care. The outdoor area was observed to be fenced, clean, free of hazardous materials, provided plenty of shade, and the bottom of the play equipment was cushioned to decrease injuries.

{report continues on pg. 2}
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Ericka HillTELEPHONE: (424) 301-3029
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2021
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MIKAYELYAN FAMILY CHILD CARE
FACILITY NUMBER: 197494185
VISIT DATE: 05/12/2021
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LPA observed the family child care home following COVID-19 guidelines related to having a thermometer, gloves, signs posted, disinfecting products, and hand sanitizer.

An exit interview was conducted with the Applicant. A copy of this form, (LIC809), was provided to the Applicant. LPA Hill requested the Applicant to read, sign, and email the the LIC809 back to LPA Hill.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Ericka HillTELEPHONE: (424) 301-3029
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2021
LIC809 (FAS) - (06/04)
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