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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020224
Report Date: 04/24/2019
Date Signed: 05/15/2019 01:40:02 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:KHANJYAN & GABRIELYAN FAMILY CHILD CAREFACILITY NUMBER:
198020224
ADMINISTRATOR:H.KHANJYAN & A.GABRIELYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 445-3139
CITY:LA CRESCENTASTATE: CAZIP CODE:
91214
CAPACITY:14CENSUS: 0DATE:
04/24/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Hasmik Khanjyan/Alis Gabrielyan, Applicant'sTIME COMPLETED:
03:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Carlos Gonzalez conducted an announced Pre-licensing inspection on this date. LPA met with Hasmik Khanjyan and Alis Gabrielyan, Applicant’s, who guided Analyst on a tour of the facility. Also present were Hakop Gabrielyan, Sirapi Barsegian, and Tony Gabrielyan. Per Applicant’s, hours of operation will be from 7:00 AM to 7:00 PM, Monday thru Friday.

All areas on the facility sketch were inspected. This is a single-story home which consists of two (2) bedrooms, one (1) bathroom, living room, dining room, and kitchen. Children will have access to the living room, bathroom, and dining room area. Off-limits to children in care are both bedrooms, and kitchen. LPA observed a detached guest house, located in the rear back yard, and occupied by Sirapi Barsegian.

The facility was inspected for comfort, cleanliness, telephone service (land line), ventilation, and heating (central air/heat). Hakop/Alis Gabrielyan, and Hasmik Khanjyan, reside in the main home (front), where care will be provided. Detergents, cleaning compounds, medicines, sharp objects, and hazardous items that can pose a danger to children, were inaccessible.

Per Applicant’s, there are no firearms, weapons, or pets on the premises. LPA did not observe any bodies of water on the premises. The rear back yard will be used for outdoor play. Applicant’s were advised that 100% supervision is required at all times when children are playing outdoors.

There are age appropriate toys for children. LPA observed a fully charged 1-A:10-B:C fire extinguisher. The combination smoke and carbon monoxide detector was tested and is operable.
Report continues on next page 1 of 2
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Carlos GonzalezTELEPHONE: (323) 981-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2019
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: KHANJYAN & GABRIELYAN FAMILY CHILD CARE
FACILITY NUMBER: 198020224
VISIT DATE: 04/24/2019
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Applicant’s have completed the preventative health and safety training and First Aid/CPR. Hasmik Khanjyan’s First Aid/CPR expires on 07/2020 and Alis Gabrielyan’s First Aid/CPR expires on 12/2020.

The following was discussed with the Applicant’s:
- Incidental Medical Services (IMS) policy.
- Individual’s who are 18 years of age or older, living in the home, must obtain a criminal record clearance. Individual’s within one (1) month of their 18th birthday, must be fingerprinted immediately.
- No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, or any other item that falls into that category, are not permitted in the facility.
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The following was also discussed:
- Children forms/records, facility forms/records, and information to be posted. Disaster drills, posting requirements, injury/death reporting, and criminal record transfer requirements.

The following is contingent prior to licensure:
- Applicant’s to acquire a 2-A:10-B:C fire extinguisher or higher and submit proof to LPA (receipt).

Exit interview conducted with Hasmik Khanjyan, who was in agreement with the above.
Report ends page 2 of 2
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Carlos GonzalezTELEPHONE: (323) 981-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2