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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021033
Report Date: 09/15/2022
Date Signed: 09/15/2022 02:15:51 PM


Document Has Been Signed on 09/15/2022 02:15 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:MNATSAKANYAN FAMILY CHILD CAREFACILITY NUMBER:
198021033
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
09/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Gohar Mnatsakanyan, LicenseeTIME COMPLETED:
02:30 PM
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CASE-MANAGEMENT INSPECTION CONDUCTED IN ARMENIAN
Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced case- management inspection to the above facility on 09/15/2022 due to licensee is requesting to use the detached converted garage for limited activity only. LPA arrived at the facility at 1:00 PM and met with Gohar Mnatsakanyan Licensee who guided analyst on a tour of the facility. During this inspection LPA observed four children were napping in daycare area.
Fire Clearance to use the garage for limited activity only was granted on 09/12/2022.
All areas identified on the facility sketch were inspected. This is a one story home located on the first level. The home consists of 3 bedrooms, 2 & 1/2 restrooms, living room, kitchen, front yard, backyard (fenced), and detached converted garage. Per licensee, parents will enter the facility thought the side gate which leads to the backyard and daycare room.
Areas that are accessible to children are as follows: Last bedroom (daycare area), bathroom in the daycare bedroom, detached converted garage for limited activity only and front part of backyard (fenced).
Areas off limits based on facility sketch submitted to children and parents include: Living room, kitchen, two bedrooms, bathroom in the bedroom adjacent to the living room, front yard, and back of backyard.
**Rooms that are off-limits need to be made inaccessible during operating hours**
LPA informed licensee that detached converted garage can only be used for limited activity only, children can not eat or sleep inside the detached converted garage. A written declaration obtained from licensee.
Per licensee she will use the detached converted garage daily from 9:00 a.m. to 12:00 p.m. and 3:00 p.m. to 5:00 p.m... Per licensee, children will eat either outside or inside the home and sleep inside the home in daycare area.
LPA approved licensee to use the detached converted garage for limited activity only.
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.
Exit interview conducted and report was reviewed with the Licensee, Gohar Mnatsaknyan at 2:30 p.m..
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:
DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2022
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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