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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021075
Report Date: 10/20/2022
Date Signed: 10/20/2022 02:12:14 PM

Document Has Been Signed on 10/20/2022 02:12 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:YEGHNANYAN FAMILY CHILD CAREFACILITY NUMBER:
198021075
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
10/20/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Zhanet Yeghanyan, ApplicantTIME COMPLETED:
02:30 PM
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PRELICENSING INSPECTION CONDUCTED IN ARMENIAN
Licensing Program Analyst (LPA) Anomeh Eivazian conducted an announced pre-licensing follow up inspection to the above facility on 10/20/2022 for ensure all corrections from 09/27/2022 have been cleared. LPA arrived at the facility at 12:30 PM and met with Zhanet Yeghnanyan, applicant who guided analyst on a tour of the home.

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 restrooms, living room, kitchen, front yard, detached garage (storage), and backyard (fenced).
Areas that are accessible to children are as follows: Bathroom in the hallway, living room, one bedroom adjacent to the living room, kitchen, and backyard (fenced).
Areas off limits based on facility sketch submitted to children and parents include: Two bedrooms, one bathroom in the master bedroom, front yard, and detached garage (storage).
**Rooms that are off-limits need to be made inaccessible during operating hours**
There is a detached home in the back of the home with separated address: 1153 #A Justin Ave, Glendale , CA 91201. LPA observed there is a gate in the backyard to make 1153 #A home inaccessible to the children. Per applicant, 1153 #A resident will have separated commute from the back and will not trans pass from applicant's home. Per applicant, currently 1153 #A is not rented out.

LPA observed the following:
1. LPA observed railings were installed to the stairs in the backyard for additional safety.
2. Applicant will submit a copy of CA ID.
3. Applicant's daughter, Hermine Kostanyan who lives at this address, and applicant's husband, Saro Kostanyan, who does not live at this address have livescan finger prints on Licensing Information System.
REPORT CONTINUES ON NEXT PAGE 1 of 2
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2022
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: YEGHNANYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021075
VISIT DATE: 10/20/2022
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4. Applicant submitted TB test clearance, proof of immunization against MMR, TDAP, and influenza for Hermineh Kostanyan.
5. LPA toured the detached garage during this inspection. Per applicant, detached converted garage is an off-limit area. LPA observed no one lives in the detached converted garage and it is like a storage. Per applicant, currently, detached converted garage is being used by landlord.
6. Applicant submitted an updated Application LIC 279.

The following corrections need to be corrected prior to obtaining a small family child care license. Corrections are due by 10/31/22.

1. Applicant will submit a copy of City Permit to proof the back separated home is permitted and under different address. Per applicant, currently 1153 #A is not rented out and it is not in use.
2. Applicant will submit Criminal Record Statement LIC 508 for her daughter, Hermineh Kostanyan.

A small family child care license will be granted upon receipt of proof of corrections for the above. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license.
The applicant’s signature on this report acknowledges that they have signed the Application for a Family Child Care Home License (LIC 279) under the penalty of perjury that the statements on the application and any attachments are correct.

Exit interview conducted and report was reviewed with the applicant, Zhanet Yeghanyan at 2:30 p.m..

REPORT END 2 of 2
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
LIC809 (FAS) - (06/04)
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