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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700596
Report Date: 09/05/2023
Date Signed: 09/05/2023 09:53:29 PM

Document Has Been Signed on 09/05/2023 09:53 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:KIRAKOSYAN FAMILY CHILD CAREFACILITY NUMBER:
197700596
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
09/05/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Vahe KirakosyanTIME COMPLETED:
04:45 PM
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On 9/06/2023 Licensing Program Analyst (LPA) Isabel Ortega conducted an unannounced Case management inspection as Licensee is
requesting to increase of capacity from 8 children to 14 children. The LPA
disclosed the purpose of the inspection and was granted entry by Licensee who
guided the LPA on a tour of the facility. Upon entry to the facility the LPA observed
6 children in care and two staff providing care and supervision.

Licensee was initially licensed on 08/02/2022 as a Small Family Child Care Home.
The Fire Department has inspected the home and granted a fire clearance for 14
children effective 08/23/2023.

This is a one-story single-family home. There is a living room, dining room, kitchen, three bedrooms, two restrooms, one shed, front yard and back yard. Main care is provided in the in room #1 and #2 referred to as the Child Care Play areas. Licensee provides children with cots and playpens for infants when napping. The off-limits areas are bedroom #3, one restroom, the shed which is utilized for storage (maintained key locked). According to Licensee he participates in the Food Nutrition Program. Licensee provides breakfast, lunch, afternoon snack and dinner as needed.

The operational childcare hours are Monday through Friday from 7:30 a.m. to 6:00 p.m.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KIRAKOSYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700596
VISIT DATE: 09/05/2023
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The First Aid kit with a temperature thermometer was observed and complete. The required fire extinguisher (2A10BC) is reading in green. Smoke and carbon monoxide detectors were found to be in operating condition. Fire and disaster drills are conducted every six-month last drill recorded was on 05/18/2023 at 3:30 p.m.

Licensee’s CPR/First Aid training certificate does not expire until 8/01/2024.
Child Care Provider Mandated Reporter (AB1207) Training Certificate is dated 08/01/2023.

Licensee was reminded with a capacity increase he must have a qualified assistant present whenever he has more than 8 children in care. Licensee was provided with a capacity and ratio handout pertaining to large Family Child Care Homes and the various age groups that can be under care at one given time.

Licensee has met Title 22 regulations; Fire clearance was granted 8/23/2023, therefore, a Large Family Child Care Home License capacity of 14 children has been granted effective today 9/05/2023.

An exit interview was conducted, and a copy of this report, appeal and notice of site visit was provided to Licensee on this day. All Licensing reports are recommended to be kept on file for minimum three years. Notice of site visit shall be posted for 30 days.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023
LIC809 (FAS) - (06/04)
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