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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494050
Report Date: 12/20/2021
Date Signed: 12/20/2021 04:33:46 PM

Document Has Been Signed on 12/20/2021 04:33 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:HAKOBYAN FAMILY CHILD CAREFACILITY NUMBER:
197494050
ADMINISTRATOR:HAKOBYAN, KARINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(228) 707-7007
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
12/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Karina Hakobyan, Licensee TIME COMPLETED:
04:35 PM
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On 12/20/2021 12:55PM, Licensing Program Analyst (LPA), Denise Miranda, conducted an unannounced Annual Required Inspection and LPA met with Licensee, Karine Hakobyan. Days and hours of operation are Monday-Friday 7:00AM -7:00PM.

LPA observed all required documents to be posted, posted in a publicly accessible area at facility. LPA toured the home inside and outside and observed no children, per licensee no children show up today. LPA toured the home inside and outside and a census was taken. Licensee was provided a facility check list (LIC 126).

During this inspection it was reviewed the facility’s sketch and does not match with the floor plan and yard of the facility. A revised form LIC999A(floor plan and yard) will be mail to RO no later than 12/2/7/2021.

The following it was observed: off limit area - Bedrooms #1, #2 and Bathroom#2, kitchen area and made inaccessible with by use latches on the doors. Also, dining room and living room are off-limit areas.

LPA observed a house in construction located on the backyard of the premises, per signed observed in front of the house, the back house will have different address (1525 N. Screenland Drive, Burbank, CA 91505. Per licensee, that area it was the detached garage previously (off-limit). Per Licensee, the construction started back on 12/18/2021, this construction it was reported during this inspection. All the backyard area is off limit and no children were observed during this inspection on this area. There is no swimming pool or other bodies of water on the premises.

The on-limit area are: bedroom#1 (day care), bathroom#1, and front yard.

Parents will use the driveway to access the main entrance at the facility (bedroom#1). Licensee will not provide care at the driveway area.

SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Denise Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2021
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: HAKOBYAN FAMILY CHILD CARE
FACILITY NUMBER: 197494050
VISIT DATE: 12/20/2021
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Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating (Central air) and ventilation for safety and comfort. There are no stairs in this home. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (228) 707-7007.

There are currently no infants enrolled in care. Per licensee and application form (LIC279), Licensee served age group from 0 year old to 12 years old.

LPA discussed Safe Sleep Regulations with licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backside and backyard of the house is fenced and it is off limit due the construction of the back house. No children has access to the backyard area. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter Training completed on 09/08/2019, technical violation it was provided to licensee. Licensee’s pediatric CPR/First Aid expired on 03/2023. Per Licensee, no staff/volunteer is working now. All adults who reside in the home have a criminal record clearance or exemption.


Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.
LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Staff interview conducted and documented at 3:37PM.


Exit interview conducted and copy of this report was provided to Licensee.
SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Denise Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021
LIC809 (FAS) - (06/04)
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