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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016405
Report Date: 05/13/2021
Date Signed: 05/17/2021 10:49:45 AM

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: 20DATE:
05/13/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Carmen Derkrikorian and Michael PanosianTIME COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA) Crystal Green conducted an announced case management inspection to evaluate the facility's request to add a toddler option program. Due to COVID-19 and precautionary measures, this inspection was conducted with Licensee Carmen Derkrikorian and Administrator, Michael Panosian, via a tele-inspection by use of FaceTime. Licensee is requesting to decrease the preschool capacity and add a toddler option program.

At 11:00 AM, Licensing staff was guided through a tour of the proposed toddler option classrooms, the designated outdoor area, and the existing preschool program. The facility is currently operating and a total of 20 children with 3 staff were observed. This facility has a total of 4 Classrooms. The proposed toddler option classroom will be located in Classroom #4. LPA observed the toddler classroom area to be physically separate from the Preschool classrooms. LPA also observed 3 cribs and cots available from the toddlers. LPA observed portable drinking water with disposable cups available in the classroom. There are age-appropriate toys available for children in care. Furniture and equipment were inspected for good repair, free of sharp, loose, or pointed parts. All toilets and handwashing facilities are in safe and sanitary operating conditions. All materials and surfaces accessible to children are toxic-free. At this time, the front room is used as an isolation area. Licensing staff was guided through the proposed outdoor toddler space. There is adequate shade in the outdoor play area. The outdoor play equipment was observed to be in good condition, free of sharp, loose, or pointed parts. Outdoor activity space surface is maintained in a safe condition as is free of hazards. Report Continues Page 1 of 2

SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Crystal GreenTELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2021
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: 05/13/2021
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LPA obtained measurements for the proposed toddler classroom during a case management inspection conducted on 5/10/2021. Based on those measurements obtained, capacity for the proposed toddler program will be (6) six, and the preschool capacity will be reduced to (29) twenty-nine.

The exit interview was conducted with Carmen Derkrikorian and Micheal Panosian. This report along with a copy of the appeal rights will be sent to the Licensee via email with a read receipt or confirmation of receipt of the email, which will act as the Licensee’s signature.

Report Ends Page 2 of 2.

SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Crystal GreenTELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2