<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700489
Report Date: 09/08/2023
Date Signed: 09/08/2023 01:36:37 PM

Document Has Been Signed on 09/08/2023 01:36 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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:HAKHVERDYAN FAMILY CHILD CAREFACILITY NUMBER:
197700489
ADMINISTRATOR:EVA HAKHVERDYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 934-6834
CITY:SUNLANDSTATE: CAZIP CODE:
91040
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
09/08/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:48 PM
MET WITH:Eva Hakhverdyan, LicenseeTIME COMPLETED:
01:30 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 09/08/2023, Licensing Program Analysts (LPAs) Justeene Tamayo and Evelyn Garcia conducted a Case Management inspection at the above facility. LPA met with licensee. Upon initial walk through, LPAs observed 2 infants and 3 preschool children in care, along with assistant #1 and adult #1. LPA observed adult #1 providing care to children. LPAs observed adult #1 leave the facility due to being uncleared. Licensee is aware that all adults 18 and over must be fingerprint cleared and associated before assisting with children.

The Facility has been cited a Type A deficiency according to the California Code of Regulations of Title 22 . Please see Facility Evaluation Report 809-D for deficiencies. A immediate civil penalty of $300 has been assessed.

Upon receipt of a Type A deficiency licensee shall post the report for 30 days in addition to the Notice of Site Visit and provide copies of the licensing report to parents/guardians of children in care at the facility. This report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months and licensee will obtain a signed acknowledgment of Licensing Reports (LIC9224) from parent/guardian and place it in each child's file. If these requirements are not met, civil penalties will be assessed.

An exit interview was conducted with licensee, a copy of this report was read, discussed and provided to licensee, along with the appeal rights and notice of site visit.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Evelyn Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2023
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
Document Has Been Signed on 09/08/2023 01:36 PM - It Cannot Be Edited


Created By: Evelyn Garcia On 09/08/2023 at 12:53 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: HAKHVERDYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700489

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
09/08/2023
Section Cited
CCR
102370(d)(1)

1
2
3
4
5
6
7
Criminal Record Clearance 102370(d)(1): All individuals subject to a criminal record review pursuant to Health and Safety..... shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance...by the Department...
This requirement is not met as evidence by:
1
2
3
4
5
6
7
LPAs observed adult #1 leave the facility. LPAs provided licensee with a live scan form. Licensee is aware no adults shall assist with day care children without a fingeprint clearance.
8
9
10
11
12
13
14
LPAs Tamayo and Garcia observed adult #1 assisting with day care children without a fingerprint clearance, which poses an immediate health and safety risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mariela Ramon
LICENSING EVALUATOR NAME:Evelyn Garcia
LICENSING EVALUATOR SIGNATURE:
DATE: 09/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2023


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