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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021085
Report Date: 11/21/2022
Date Signed: 11/21/2022 01:53:40 PM

Document Has Been Signed on 11/21/2022 01:53 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:KHACHATRYAN FAMILY CHILD CAREFACILITY NUMBER:
198021085
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/21/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Susanna Khachatryan, ApplicantTIME COMPLETED:
02:10 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 11/21/2022. LPA arrived at the facility at 12:20 PM and met with Susanna Khachatryan, Applicant who guided analyst on a tour of the facility. During this inspection, Liana Sahakyan applicant's daughter in-law was also present.

During this inspection LPA observed the following:
1. LPA observed applicant added a plastic door knob and a plastic lock to the main entrance door for additional safety.
2. Applicant have a working telephone services available in the home via a cellphone that will stay in the home during daycare hours. The phone number is (747)344-2877.
3. LPA observed applicant added a gate and additional fencing in the backyard in a way to make the second and third levels of the backyard (off-limit) areas inaccessible to the children for additional safety from the pool area .
4. Applicant provided a DMV change of location proof under facility address for herself.
5. Applicant submitted an updated facility sketch for Yard plan.
6. LPA observed pool gate swing away from body of water with self-closing latch. Per applicant, pool gate will be kept locked all the times. (Pictures were taken).
7. LPA observed applicant added a plastic latch on the backyard gate which leads to the drive way for additional safety.
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, Susanna Khachatryan at 2:10 p.m..
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2022
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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