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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020748
Report Date: 07/02/2024
Date Signed: 07/02/2024 11:31:35 AM

Document Has Been Signed on 07/02/2024 11:31 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:KHODAGULYAN FAMILY CHILD CAREFACILITY NUMBER:
198020748
ADMINISTRATOR/
DIRECTOR:		MONIKA KHODAGULYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 580-8989
CITY:MONTROSESTATE: CAZIP CODE:
91020
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
07/02/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:58 AM
MET WITH:Monica Khodagulyan TIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 07/02/2024 , at 11:00 am , Licensing Program Analyst(LPA) Shushanik Safaryan conducted an unannounced POC (Plan of Correction) inspection to the above facility to ensure Type B deficiency cited on 05/07/2024 has been cleared. Upon arrival LPA met with Monica Khodagulyan , licensee who guided analyst on a tour of the facility.
During this inspection 7 children were present in the home, from which only one infant .During the visit LPA reviewed 5 children files . Children files were complete .

During the visit, LPA cleared deficiency cited on 05/07 /24 and provided a copy of the Licensing Report to Licensee and issued POC clearance letter.

The Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE: DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2024
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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