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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020549
Report Date: 09/07/2023
Date Signed: 09/07/2023 10:56:14 AM

Document Has Been Signed on 09/07/2023 10:56 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:GYUMUSHYAN FAMILY CHILD CAREFACILITY NUMBER:
198020549
ADMINISTRATOR:MARIAM GYUMUSHYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 376-2838
CITY:LOS ANGELESSTATE: CAZIP CODE:
90027
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
09/07/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Mariam Gyumushyan, LicenseeTIME COMPLETED:
11:10 AM
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On September 7, 2023, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced Plan Of Correction (POC) inspection at the above facility. LPA met with licensee, Mariam Gyumushyan who guided LPA on a tour of the facility.

The purpose of this inspection is to ensure that the facility is in compliance with Title 22 Regulations and that the deficiency cited on 08/02/2023 was corrected.

The following was reviewed during the inspection:

  • LPA observed 2 infants in care. Per licensee, there are only 3 infants enrolled; LPA observed current facility roster.

Letters of Deficiencies Citations Cleared were provided for deficiency corrected.

An exit interview was conducted and a copy of this report was provided to the licensee. A Notice of Site Visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2023
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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