195700747-5-7-2026-58-CC-AMOS-DTUQ2R-20260507114734

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195700747
Report Date: 05/07/2026
Date Signed: 05/07/2026 11:47:56 AM

Document Has Been Signed on 05/07/2026 11:47 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	KARAPETYAN FAMILY CHILD CARE		FACILITY NUMBER:	195700747
ADMINISTRATOR/ DIRECTOR:	SHAKE KARAPETYAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 579-3678
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91605
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	05/07/2026
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Shake Karapetyan		TIME VISIT/ INSPECTION COMPLETED:	12:05 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 5/7/2026 at 9:00AM, Licensing Program Analyst (LPA) Amelia Morales conducted an announced pre-licensing inspection. The purpose of the inspection was to ensure that the health, safety, and personal rights as required by Title 22 Regulations governing California Family Child Care Homes will be met by the applicant. Upon arrival LPA Morales was greeted and let into the residence by Shake Karapetyan and applicants son Narek Poghosyan. LPA was guided on a tour of the residence. An entrance checklist was provided. This is a change of location; previous licensing number was 195700429. Applicant understands once the new residence is licensed, care can no longer be provided at the other address. Applicant is requesting a Large capacity of 14 children ages newborn to 13 years old. The Fire clearance was granted on 4/30/2026 by LA City Fire Prevention Bureau. Per applicants the Family Child Care Home will operate Monday through Saturday from 7:00 AM to 11:00 PM. Licensee stated that a cell phone with active service will be the main contact number while children are in care. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a one story home the consist off: front yard , three bedrooms, two bathrooms, kitchen, living room, living/dining room(child care room), play room, laundry room, backyard (fenced), enclosed patio, and storage #1 (shed). Per applicant parents will use the side entrance located on the left side of the home to enter. It should be noted that the facility is part of duplex property, with other property separate address (7038 Alcove Ave. North Hollywood CA 91605), the other property has a different entry way and is off limits to the children in care. LPA did not observe another entry way inside the home, the home is divided by a wall. Applicants home is separated by wooden fence, in the backyard . Page 1 of 5

NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Amelia Morales
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/07/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: KARAPETYAN FAMILY CHILD CARE	FACILITY NUMBER: 195700747
	VISIT DATE: 05/07/2026

NARRATIVE

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These areas will be off-limits to the children in care: living room, bedroom #1, bedroom #2, and bedroom #3, these areas are made inaccessible by the use of a baby proof safety door locks. Bathroom #2 is located inside bedroom #3 and is off limits to the children in care. The kitchen will also be off limits, and made inaccessible by the use of a baby gate. Kitchen cabinets and drawers were observed with child safety locking mechanism. The stove, refrigerator, sink and counter space area were observed and inspected. Per Applicant, the home will provide food for children in care (breakfast, lunch, dinner and PM snack). Per Applicant children will eat in the playroom. The laundry room is off limits to the children in care and has a key lock. There is an enclosed patio located in the backyard that is off limits and has a latch lock, located at the top of the door. Behind the enclosed patio there is storage#1 (shed), that is locked and are off limits to the children in care.

The areas that will be accessible to the children in care are: front yard, bathroom #1, living room/dining room (child care room), playroom and the backyard (fenced).For napping equipment there were multiple cots and two play yards in the living room/dining room (child care room), per applicant sheets will be provided by applicant and will be laundered every Friday by applicant. The required fire extinguisher(size 2A:10-B:C) was located in the playroom mounted was purchased on 3/24/2026. LPA informed Applicant that the required fire extinguisher(size 2A:10-B:C) must be purchased or recharged yearly. Per applicant, there are no weapons or firearms of any kind in the facility. LPA discussed that when a child shows signs of illness, they shall be separated from other children until they are picked up. The isolation area will be in the playroom, separate from other children in care.

The backyard (fenced) will be on limits to the children in care. Per applicant, they will visually supervise children at all times and never leave children unattended. There are no bodies of water on the premise.

LPA observed the following: the home is clean and orderly. There were age appropriate toys and play items. Applicant was informed that baby-walkers, bouncers, jumpers, and other prohibited items will not be used for children in care. All electrical outlets have safety covers. There was a carbon monoxide detector located in the hallway and smoke detectors in each room all detectors were tested and found to be operable. LPA did not observe any pets in the home.

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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Amelia Morales
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/07/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: KARAPETYAN FAMILY CHILD CARE	FACILITY NUMBER: 195700747
	VISIT DATE: 05/07/2026

NARRATIVE

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The applicant completed Preventive Health and Safety/Childhood Nutrition/ Lead Exposure Prevention on 7/20/2024 and Mandated Reporter training on 7/28/2024. The applicant has current Pediatric CPR/First Aid training completed on 7/16/2024, applicant completed Family Child Care Home Orientation on 8/2/2024. LPA Morales reminded applicant that Mandated Reporter Certification and Pediatric CPR/First Aid training must be done every two years. LPA Morales informed applicant that Pediatric CPR/First Aid training must be done in person and never online.

LPA reviewed with applicant form LIC 311D Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted; LIC 610A Emergency Disaster Plan, LIC 9148 Earthquake Preparedness Checklist, and PUB394 Notification of Parents Rights Poster. LPA advised that once licensed, the facility license shall be posted. A fire/disaster drill log shall be available and performed at least every six months. LPA informed Applicant any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.

Applicant, was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Because the applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC 9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Amelia Morales
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/07/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026

LIC809 (FAS) - (06/04)

Page: 4 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: KARAPETYAN FAMILY CHILD CARE	FACILITY NUMBER: 195700747
	VISIT DATE: 05/07/2026

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA discussed the safe sleep regulations with [applicant, licensee, or facility representative] and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed [applicant, licensee, or facility representative] of the importance of checking for and removing recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

When asked if a parent brings an infant in their care seat to the facility, what would they do. Applicant stated that they have never accepted infants in car seats.

On this date, 3/25/2026, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility address. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Amelia Morales
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/07/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026

LIC809 (FAS) - (06/04)

Page: 5 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: KARAPETYAN FAMILY CHILD CARE	FACILITY NUMBER: 195700747
	VISIT DATE: 05/07/2026

NARRATIVE

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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters, and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/communitycare-licensing/subscribe and select the Child Care option to receive email communication.

If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Exit interview conducted and report was reviewed with the applicant Shake Karapetyan.

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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Amelia Morales
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/07/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026

LIC809 (FAS) - (06/04)

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