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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198013874
Report Date: 04/28/2023
Date Signed: 04/28/2023 08:33:13 AM


Document Has Been Signed on 04/28/2023 08:33 AM - It Cannot Be Edited

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



FACILITY NAME:HAIRAPETIAN FAMILY CHILD CAREFACILITY NUMBER:
198013874
ADMINISTRATOR:HAIRAPETIAN, MADLENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 248-2628
CITY:LA CRESCENTASTATE: CAZIP CODE:
91214
CAPACITY:14CENSUS: 0DATE:
04/28/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Madlen Hairapetyan, LicesneeTIME COMPLETED:
08:45 AM
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CASE MANAGEMENT INSPECTION CONDUCTED IN ARMENIAN

Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced case management inspection to the above facility on 04/28/23 to amend the CM inspection report dated 04/26/23. LPA arrived at the facility at 8:20 AM and met with Madlen Hairapetian, Licensee. Licensee did not allow LPA Eivazian to enter the facility, LPA read the report to licensee while standing in the porch in front of the door. Per licensee, no children were present in the home.

A copy of the amended report was discussed and a copy of the amended report was provided to Licensee, Madlen Hairapetian during this inspection.

No citations being issued today.

Exit interview conducted and report was reviewed with the Licensee, Madlen Hairapetian at 8:45 a.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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