198021125-1-20-2023-33-CC-AEIN-CN9TGH-20230120134311

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198021125
Report Date: 01/20/2023
Date Signed: 01/20/2023 01:43:16 PM

Document Has Been Signed on 01/20/2023 01:43 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:	HAKOBYAN FAMILY CHILD CARE		FACILITY NUMBER:	198021125
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	01/20/2023
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	12:10 PM
MET WITH:	Arpik Hakobyan, Licensee		TIME COMPLETED:	02:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	CASE- MANAGEMENT INSPECTION CONDUCTED IN ARMENIAN Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced case- management inspection to the above facility on 01/20/2023 for the purpose of adding detached garage as limited activity space. LPA arrived at the facility at 12:00 PM and met with Arpik Hakobyan, Licensee who guided analyst on a tour of the facility. During this inspection Liparit Hambardzumyan, licensee's son was also present in the home. Per licensee operation hours will be Monday to Friday, 7:00 a.m. to 10:00 p.m.. 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, detached garage, front yard and back yard (fenced). Per licensee, parents will enter the home from the main entrance which leads to the living room and side gate which leads to the backyard. Areas that are accessible to children are as follows: Bathroom in the hallway, living room (main day care area), one bedroom adjacent to the living room, kitchen, front part of backyard (fenced), and detached garage for limited activity only. Areas off limits based on facility sketch submitted to children and parents include: Two bedrooms in the hallway, one bathroom in the master bedroom, front yard, and back of back yard (patio). Rooms that are off-limits need to be made inaccessible during operating hours Fire Clearance to use the detached garage for limited activity only was granted on 01/17/23. Per licensee, children will use the detached garage for limited activity only anytime from 9:30 AM-12:00 PM and 3:00 PM to 5:00 PM. Per licensee, children will not eat or sleep inside the detached garage. Per licensee, children will eat and sleep inside the main home. REPORT CONTINUES ON NEXT PAGE 1 of 2

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

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: 198021125
	VISIT DATE: 01/20/2023

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At 12:40 p.m. the licensee began touring LPA’s through the detached garage for limited activity only. LPA observed children tables, chairs and toys in the detached garage.

LPA advised licensee, children are allowed to use the detached garage only and only for limited activity. LPA informed licensee, children can not eat or sleep in the detached garage.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today from the areas that were inspected today.

LPA approved licensee to use the detached garage for limited activity only at this time.

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, Arpik Hakobyan at 2:00 p.m..

REPORT END 2 of 2

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

LIC809 (FAS) - (06/04)

Page: 2 of 2