198021063-11-2-2022-33-CC-AEIN-CKSPWD-20221102114033

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198021063
Report Date: 11/02/2022
Date Signed: 11/02/2022 11:40:49 AM

Document Has Been Signed on 11/02/2022 11:40 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:	HAKOBYAN FAMILY CHILD CARE		FACILITY NUMBER:	198021063
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	11/02/2022
TYPE OF VISIT:	Office	ANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Zohrap Hakobyan, Applicant		TIME COMPLETED:	11:30 AM

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Licensing Program Manager (LPM) Christina Gabelman and Licensing Program Analyst (LPA) Anomeh Eivazian met with applicant, Zohrap Hakobyan and Ani Jaloyan, applicant’s wife on 11/02/2022 at 10:30 AM in Monterey Park Regional Office. The purpose of this office meeting is for the department to go over the expectations of a licensed childcare provider due to applicant’s wife, Ani Jaloyan is licensed provider at 1009 E. Maple Street, Glendale, CA 91205 with facility number 198019136. LPA Eivazian reviewed and discussed with the applicant the following Title 22 Regulations to ensure applicant will maintain compliance and meet the Title 22 regulations at all times. This report was translated to Armenian by LPA Eivazian.

Provider must reside in the home where care is being provided:

Definitions--102352 -- "Family Day Care" or "Family Child Care" means regularly provided care, protection and supervision of children, in the care giver's own home, for periods of less than 24 hours per day, while the parents or authorized representatives are away. The term "Family Child Care" supersedes the term "Family Day Care" as used in previous regulations and "Home" means the licensee's residence as defined by Government Code Section 244.

Provider must be present 80% of the time providing care as stated in the following regulation:

Operation of a Family Child Care Home--102417 (a)-- The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

REPORT CONTINUES ON NEXT PAGE 1 of 3

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: HAKOBYAN FAMILY CHILD CARE	FACILITY NUMBER: 198021063
	VISIT DATE: 11/02/2022

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Definitions--102352 (a) (3)--"Assistant Provider" means a person at least 14 years of age who is primarily involved in caring for children during the hours that the home provides care.

Reporting Requirements--102416.2 (a) (2)--Any change in household composition including adults moving in or out of the home and anyone living in the home who reaches his or her 18th birthday.

Inspection Authority of the Department—102391 (a)--Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation of, the regulations adopted by the Department governing family child care homes, and in accordance with Section 102396.

Staffing Ratio and Capacity--102416.5 (a)--The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.

LPA Eivazian reviewed transportation requirement with applicant. Per applicant he will provide transportation to children if it will be needed. Per applicant, he will ensure to have fully qualified assistant present in the home during applicant’s absence from the home. LPA advised applicant that age appropriate car seats also need to be utilized when transporting children.

During pre-licensing inspection LPA Eivazian observed second floor is under construction and unfinished. Per applicant, second floor will be off-limit to children and once applicant decided to complete second floor construction will contact LPA Eivazian ahead of time and discuss his plan to ensure children in care will be in safe and healthy environment during second floor construction. Per applicant, even when second floor construction will be finished, second floor will stay off-limit area to the daycare children.

- Applicant will interact with Department staff professionally and respectfully at all times. Applicant understands that inspections are conducted in person, unannounced, and Department staff will be granted access to the facility as part of the inspection process.
- Applicant will be forthright with the department all the times to ensure the health and safety of children in care.

REPORT CONTINUES ON NEXT PAGE 2 of 3

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022

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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: HAKOBYAN FAMILY CHILD CARE	FACILITY NUMBER: 198021063
	VISIT DATE: 11/02/2022

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Applicant and his wife submitted written declaration regarding applicant will live at his address and applicant’s wife will live at her address. Per applicant, their biological children will stay either with applicant or his wife. LPA Eivazian, explained if children are younger than 10 years old, once they are home they will be counted toward the ratio.

Applicant submitted two bills under his name. However, the home mortgage is under applicant’s wife only, Ani Jaloyan name. During this office meeting Ani Jaloyan submitted a written declaration to the department giving applicant permission to operate Day care at this address.

LPA reviewed applicant's wife facility file and observed applicant is listed on application form LIC 279 and rental agreement under his wife's facility, Jaloyan Family Child Care, 198019136. LPA Eivazian asked applicant to submit an updated rental agreement for Ani Jaloyan to reflect applicant, Zohrap Hakobyan does not live at his wife's address anymore. During this office meeting Ani Jaloyan submitted an updated application form LIC 279.

LPA advised the applicant to access forms, regulations, quarterly updates and providers information notices (PIN) online at: www.ccld.ca.gov

The following CCLD training videos were recommended to the applicant to view and apply to the operation of the facility.

· Child Care Reporting Requirements
· Background Check Requirements for Caregivers
· Supervising Children in Family ChildCare- How Many Children Can Attend a Family Child Care Home?
· Link to the videos identified above https://cdss.ca.gov/inforesources/child-care-licensing.

Exit interview conducted and report was reviewed with the Applicant, Zohrap Hakobyan at 11:30 AM..

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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022

LIC809 (FAS) - (06/04)

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