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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700462
Report Date: 08/26/2026
Date Signed: 08/26/2026 03:04:54 PM

Document Has Been Signed on 08/26/2026 03:04 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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:YERITSYAN FAMILY CHILD CAREFACILITY NUMBER:
197700462
ADMINISTRATOR/
DIRECTOR:		TATEVIK YERITSYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 530-8081
CITY:PORTER RANCHSTATE: CAZIP CODE:
91326
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 10DATE:
08/26/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:18 PM
MET WITH:Tatevik Yeritsyan: LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
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On Wednesday, August 26, 2026 Licensing Program Analyst (LPA) Maria Avalos conducted an unannounced annual inspection. LPA met with Licensee and informed Tatevik Yeritsyan licensee the purpose of the visit was to conduct an unannounced annual inspection of the facility. The facility operates Monday-Friday from 8:00am-9:00pm. Licensee provides care for children ages 0 to 12 years. LPA observed 10 napping children in care at the time of arrival licensee and assistant providing care and supervision. Licensee provided a tour of the facility, including both the indoor and outdoor areas. All adults associated with the facility have received the required background clearance.

The facility is a one-story family home consisting of a living room, kitchen, dining area, family room, 3 bedrooms, three bathrooms, attached garage, no entrance from home and front/back yards. An in-ground pool (off limits). Primary childcare area is family room referred to as the childcare play area. Family room has its own side entrance. Children utilize cots and playpen for napping. There is a designated area for the ill children as necessary.

Off-limits include bedrooms #1, #2 and #3, living room, two restrooms in the main home, dining area and kitchen, back yard where inground pool is located. LPA observed a fireplace in living room (off limits). The is a door in the kitchen that divides main home from day care family room making main home inaccessible to children in care.

LPA inspected the indoor children’s area for safety, comfort, cleanliness, ventilation and working phone (cell phone). LPA observed age-appropriate furniture, toys and books readily accessible and in good repair. Licensee tested dual smoke and carbon monoxide alarm located family room. LPA heard the sound it is operable. LPA observe fire extinguisher, 2A10BC needle fully green. LPA did not observe service tag or purchase receipt within a year.

Continue on LIC 809-C

Francisco Pedroza
Maria Avalos
DATE: 08/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2026
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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Document Has Been Signed on 08/26/2026 03:04 PM - It Cannot Be Edited


Created By: Maria Avalos On 08/26/2026 at 02:43 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: YERITSYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700462

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above expired pediatric first aid/cpr which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/05/2026
Plan of Correction
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Licensee will enrolled in pediatric first aid/cpr
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Francisco Pedroza
NAME OF LICENSING PROGRAM MANAGER:
Maria Avalos
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2026


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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: YERITSYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700462
VISIT DATE: 08/26/2026
NARRATIVE
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LPA entered the bathroom and observed the toilet, hand washing sink, hand soap. LPA reminded licensee to personal items like keep shampoos, mouthwash, razors, toothpaste, and other hazardous items need to be made inaccessible to all children in care.

LPA inspected the kitchen and observed it to be maintained in safe, sanitary, and good repair condition. LPA observed that knives are stored on kitchen countertop. Licensee stated she provides breakfast, snacks, and lunch for children in care. Licensee participates in lunch program. LPA reminded licensee that if children bring their own food, it must be properly sealed and labeled with child’s name.

LPA inspected the outdoor side yard for safety, comfort, and cleanliness. LPA observed age-appropriate toys and play equipment that were in good repair. Back yard fence all around. Shaded areas are available for children's use. LPA observe inground pool surrounded by mesh fencing measuring at 5 feet. Mesh fencing does not obscure the pool from view. Per LPA observation, mesh fence was installed in front of the off-limit master bedroom door. An additional mesh fence and gate were installed in front of the off-limit bathroom door. The fencing was installed to ensure that there was no access to the pool and jacuzzi located in the backyard from main home (off limits). LPA observed a 12-foot rescue pole with a body hook. LPA observe life ring 20 inches approved by the U.S. Coast Guard.

Licensee stated there is no smoking in the home. Per recorded documentation, Fire/Disaster drill last completed 8/01/26. Poisons, detergent, and cleaning compounds are made inaccessible to children stored in bathroom in the main home. Per licensee, there are no weapons/firearms on the premises.

LPA review a sampling of children’s files at the time of the inspection. LPA observe licensee’s Pediatric First Aid/ CPR (American Heart Association) dated on 06/11/24 it has expired. Type B violation was issued Licensee will sign up for Pediatric First Aid CPR courses and send LPA proof of registration by 9/05/26 Mandated reporter certificate dated 9/28/25.

Postings: Notice of Parent's Rights Poster (PUB 394), Facility License (LIC 203), Earthquake Preparedness (LIC 9148)

Documents Provided: Entrance Checklist, Pool Log, Sleep Log

One Type B violation was issued.

Continue on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Maria Avalos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2026
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: YERITSYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700462
VISIT DATE: 08/26/2026
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Licensee Tatevik Yeritsyan was reminded that all adults 18 and over living or working in the home, 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.

LPA discussed the safe sleep regulations with licensee Tatevik Yeritsyan 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 licensee of the importance of checking for and removing any 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.

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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; 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.

During the exit interview, the Licensee Tatevik Yeritsyan confirmed that there are no Registered Sex Offenders living in the facility.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. 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.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Tatevik Yeritsyan.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Maria Avalos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2026
LIC809 (FAS) - (06/04)
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