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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016405
Report Date: 05/10/2021
Date Signed: 05/10/2021 12:33:26 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: 14DATE:
05/10/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Carmen Derkrikorian and Michael PanosianTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Crystal Green conducted a case management inspection to the facility. Due to COVID-19 and taking precautionary measures, LPA wore a face mask to the onsite inspection. LPA met with Licensee, Carmen Derkrikorian, and Office Manager, Michael Panosian. LPA informed the Licensee the reason for the inspection was to provide waiver rescind letter to the facility.

At 10: 05 AM, Licensing staff was guided through a tour of the facility. This facility contains 4 classrooms. LPA observed the following in each classroom.

Room 1 (4-5 years old): 8 children with 2 staff
Room 2 (toddler option previously operated under the waiver): no children or staff were observed
Room 3 (2-5 years old): no children or staff were observed
Room 4 (5-6 years old): 6 children with 1 staff

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 phone call was made on 5/7/2021, prior to this inspection informing that the facility can no longer operate under the waiver. As of 5/7/2021, close of business day, the facility must cease operating under the conditions granted under the waiver. A copy of the rescinded waiver letter was issued today. No toddlers were observed at the facility during this inspection.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Crystal GreenTELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2021
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: KOMITAS DAY CARE
FACILITY NUMBER: 198016405
VISIT DATE: 05/10/2021
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During this inspection, LPA was provided documentation relating to the department decision to rescind the waiver. LPA informed licensee and office manager that the department will need to review and verify documents received. LPA discussed with Office Manager the option to apply for the toddler option. LPA obtained pictures of the proposed toddler option areas both indoors and outside.

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 and Office Manager, Michael Panosian. A copy of this report and appeal rights were provided and explained.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Crystal GreenTELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2021
LIC809 (FAS) - (06/04)
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