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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021085
Report Date: 01/06/2026
Date Signed: 01/06/2026 02:27:48 PM

Document Has Been Signed on 01/06/2026 02:27 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/
DIRECTOR:		SUSANNA KHACHATRYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(747) 272-4107
CITY:GLENDALESTATE: CAZIP CODE:
91207
CAPACITY: 14TOTAL ENROLLED CHILDREN: 1CENSUS: 1DATE:
01/06/2026
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Susanna Khachatryan, LicenseeTIME VISIT/
INSPECTION COMPLETED:
02:40 PM
NARRATIVE
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PLAN OF CORRECTION INSPECTION WAS CONDUCTED IN ARMENIAN
Licensing Program Analyst Anomeh Eivazian conducted an unannounced POC (Plan of Correction) inspection to the above facility on 01/06/2026 to ensure Type B deficiencies cited on 11/14/25 have been cleared. LPA arrived at 1:00 PM and met with Susanna Khachatryan, Licensee who guided analyst on a tour of the facility. During this inspection Liana Sahakyan, licensee’s daughter in-law, and licensee’s one biological grandchild were present in the home. The following has been observed:
During this inspection daycare children were not present in the home. Per licensee, currently she has one afterschool child enrolled in her daycare.
- Fire extinguisher was serviced on 11/17/25 as read by LPA from service tag.
The following citations have not been corrected yet.
- Licensee did not add an alarm in the swimming pool.
- Licensee did not have a life ring with a minimum exterior of 17 inches and labeled as approved by the United Stated Coast Guard.
- Licensee did not have a rescue pole with a body hook and a minimum fixed length of 12 feet were not available visible from the swimming pool and readily available for immediate use.
- Per licensee she did not perform a daily inspection of the drawing prevention safety feature and safety equipment before opening the facility and did not complete log of the inspections.
- Pool is surrounded with four feet high mesh fencing instead of 5 feet high. Also, licensee could not provide documentation that mesh fencing is complaint with ASTM F2286.
The following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.
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 Susanna Khachatryan, licensee.
NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/06/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 01/06/2026 02:27 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 01/06/2026 at 01:04 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KHACHATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021085

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/06/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/06/2026
Section Cited
HSC
1596.814(a)(1)(A)

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Pool Safety--1596.814(a)(1)(A)(vi)
(vi) For mesh fencing that does not meet the above characteristics, the licensee must provide documentation that establishes the mesh fencing is compliant with the American Society for Testing and Materials (ASTM) International Standard F2286.
This requirement is not met as evidenced by:
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Per licensee, she will ensure the pool mesh fencing to meet ASTM F2286 and have required documentation.
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Based on LPA's observation, the licensee was not able to provide documentation that mesh fencing is complaint with ASTM F2286 which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
02/06/2026
Section Cited
HSC1596.814(a)(1)(B)

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Pool Safety--1596.814(a)(1)(B)(ii)(I)
(ii) (I) An alarm that, when placed in a swimming pool, will sound upon detecting an entrance into the water. The alarm shall be turned on and be in working condition during a facility’s operating hours while the swimming pool is not in use.

This requirement is not met as evidenced by:
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Per licensee, she will have the required pool alarm by 02/06/26.
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Based on LPA's observation, the licensee did not comply with the section cited above and licensee did not have required pool alarm in the pool which poses/posed a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Christina Gabelman
NAME OF LICENSING PROGRAM MANAGER:
Anomeh Eivazian
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/06/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/06/2026 02:27 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 01/06/2026 at 01:12 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KHACHATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021085

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/06/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/13/2026
Section Cited
HSC
1596.814(a)(2)(A)

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Pool Safety--1596.814(a)(2)(A)
(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements: (2) The licensee shall have the following safety equipment visible from the swimming pool and readily available for immediate use: (A) A life ring with a minimum exterior diameter of 17 inches and labeled as approved by the United States Coast Guard.
This requirement is not met as evidenced by:
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Per licensee, she will have the required life ring with a minimum exterior diameter of 17 inches and labeled as approved by the United States Coast Guard by 02/06/26.
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Based on LPA's observation, the licensee did not comply with the section cited above and LPA did not observe required life ring in the pool area which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
02/06/2026
Section Cited
HSC1596.814(a)(2)(B)

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Pool Safety--1596.814(a)(2)(B)
(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements: (2) The licensee shall have the following safety equipment visible from the swimming pool and readily available for immediate use: (B) A rescue pole with a body hook and a minimum fixed length of 12 feet.
This requirement is not met as evidenced by:
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Per licensee, she will have the required rescue pole with a body hook and a minimum fixed length of 12 feet by 02/06/26.
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Based on LPA's observation, the licensee did not comply with the section cited above and licensee did not have required rescue pole with a body hook in the pool area which poses/posed a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Christina Gabelman
NAME OF LICENSING PROGRAM MANAGER:
Anomeh Eivazian
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/06/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/06/2026 02:27 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 01/06/2026 at 01:16 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KHACHATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021085

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/06/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/05/2026
Section Cited
HSC
1596.814(a)(3)

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Pool Safety--1596.814(a)(3)
(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements: (3) A licensee shall perform a daily inspection of the drowning prevention safety features and safety equipment before opening the facility and maintain a log of the inspections to be provided to the department upon request.
This requirement is not met as evidenced by:
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Per licensee, she will conduct a daily inspection of the drowning prevention safety features and safety equipment before opening the facility and maintain a log of the inspections to be provided to the department upon request.
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Based on LPA's observation and licensee statement the licensee did not comply with the section cited above licensee did not perform daily pool inspection which poses/posed a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Christina Gabelman
NAME OF LICENSING PROGRAM MANAGER:
Anomeh Eivazian
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/06/2026


LIC809 (FAS) - (06/04)
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