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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016405
Report Date: 04/15/2021
Date Signed: 04/15/2021 04:41:57 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
FACILITY NAME:KOMITAS DAY CAREFACILITY NUMBER:
198016405
ADMINISTRATOR:DERKRIKORIAN, CARMENFACILITY TYPE:
850
ADDRESS:1616 HILLHURSTTELEPHONE:
(323) 666-1520
CITY:LOS ANGELESSTATE: CAZIP CODE:
90027
CAPACITY:35CENSUS: 24DATE:
04/15/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:13 PM
MET WITH:Jayne ArakelyanTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Ariel Cazares conducted a case management inspection to the facility. Due to COVID-19 and taking precautionary measures, LPA wore a face mask to the on site inspection. LPA arrived at 3:13 and rang doorbell as gated door to facility was locked. At 3:18 was LPA met with Head Teacher Jayne Arakelyan and introduced herself to director. LPA informed director the purpose of the inspection was to provide waiver information for a request made by the facility. LPA asked for owner Carmen or office manager Michael. Per director, neither were in but Michael was contacted. LPA spoke to Michael who stated Carmen would be at the facility shortly. LPA requested entry to conduct the inspection. LPA was allowed in.

Upon entrance LPA observed a classroom. LPA toured the facility and the following was observed:

Room 1 (4-5 years old): 6 children and 1 staff (director)


Room 2 (toddler option operating under the waiver): 4 children and 1 staff
Room 3 (2-5 years old): 7 children and 1 staff.
Room 4 (5-6 years old): 7 children and 1 staff.

LPA observed that staff were wearing masks, but children over 2 did not have face masks. When owner arrived, LPA informed that per public health ordinances, children 2 years of age and older were to wear face masks. LPA informed her that LPA would email her a copy of the guidance for reference.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Ariel CazaresTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: KOMITAS DAY CARE
FACILITY NUMBER: 198016405
VISIT DATE: 04/15/2021
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The facility was granted a waiver dated 5/15/2020 to operate a toddler option under the licensed preschool program. Per Provider Information Notice (PIN) 20-22-CCP dated 8/25/2020, where a licensed facility requests to operate outside of the conditions of their license, a waiver with a fire clearance is required. The facility was unable to obtain a fire clearance to continue to operate under the waiver, therefore the waiver is being rescinded as of this date. A copy of the rescinded waiver letter was issued today. As of 4/23/2021, close of business day, the facility must cease operating under the conditions granted under the waiver.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Licensee Carmen Derkrikorian. A copy of this report and appeal rights were provided and explained.

SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Ariel CazaresTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2