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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198013874
Report Date: 04/26/2023
Date Signed: 04/28/2023 08:32:54 AM


Document Has Been Signed on 04/28/2023 08:32 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 04/27/2023 03:48 PM

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

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***AMENDED REPORT***
At 4:45 p.m. Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced case management inspection to above facility on 04/26/23. LPA met with Madlen Hairapetian, Licensee who guided analyst on a tour of the facility. During this inspection licensee's biological child was present in the home. During this inspection there was 0 day care children present in the home.

LPA Eivazian informed the licensee of the following:
Pursuant to the California Code of Regulations, Title 22, Div 12, Section 102370(n)(1), she must immediately
cease operation of the facility for up to 30 days.

The licensee was also advised that she may present a written appeal, including her current address and
telephone number, to the Monterey Park Child Care Regional Office at 1000 Corporate Center Drive, Suite 200B, Monterey Park, CA 91754. After the Department receives the appeal and any supporting documentation, it will review the appeal and notify the licensee of its decision within five (5) working days.

Per licensee, Madlen Hairapetian, she surrendered her Family Child Care Home License as of today, 04/26/23 and will not provide care to children anymore. Per licensee, the Police took facility license on 04/24/23. A written declaration was obtained from licensee regarding her facility closure.
No citation being issued during today's inspection.

The Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.
Exit interview conducted with Madlen Hairapetian, Licensee at 5:30 p.m..
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2023
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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