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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021360
Report Date: 11/29/2023
Date Signed: 11/29/2023 03:11:45 PM

Document Has Been Signed on 11/29/2023 03:11 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:GASPARYAN FAMILY CHILD CAREFACILITY NUMBER:
198021360
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/29/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Margarit Gasparyan, ApplicantTIME COMPLETED:
03:00 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 11/29/2023. LPA arrived at the facility at 1:20 PM and met with Margarit Gasparyan, Applicant who guided analyst on a tour of the facility.

The following were observed during this inspection:

1. Applicant added a door chain lock and a plastic door knob latch to the main entrance door for additional safety.
2. Applicant anchored the dining room fire place screen to the wall.
3. LPA observed a child safety gate was installed to one entrance of kitchen in the living room. Also, LPA observed a child safety latch was installed to the kitchen cabinet where applicant stores sharp items and knives to make it inaccessible to the children in the kitchen.
4. Applicant submitted proof of immunization against Measles (MMR) and Pertussis (TDAP) for her husband.
5. Applicant submitted a declaration that backyard gate will be kept locked and closed all the times.

LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

LPA Eivazian explained to applicant that Applicant is required to operate separately from other providers regardless of family relationships. Applicant’s family member, Marine Mehrabyan is licensed provider with facility number 198018640, located at 1322 Highland Avenue, Glendale, CA 91202.


REPORT CONTINUES ON NEXT PAGE 1 of 2
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2023
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: GASPARYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021360
VISIT DATE: 11/29/2023
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- 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.
- Applicant will be the main person to provide care to the children and interact with families.

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, Margarit Gasparyan at 3:00 PM.

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

DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2