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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021370
Report Date: 01/09/2024
Date Signed: 01/09/2024 09:15:42 AM

Document Has Been Signed on 01/09/2024 09:15 AM - 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:KIRAKOSYAN FAMILY CHILD CAREFACILITY NUMBER:
198021370
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
01/09/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Armine Kirakosyan, ApplicantTIME COMPLETED:
09:30 AM
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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 01/09/2024. LPA arrived at the facility at 8:30 AM and met with Armine Kirakosyan, Applicant who guided analyst on a tour of the facility. During this inspection Arman Mkhitaryan, applicant husband was also present tin the home. Per applicant operation hours will be Monday to Friday, 7:30 a.m. to 6:00 p.m.. Applicant states she will care for children 0-13 years old.

The following were observed during this inspection:
1. Applicant submitted an updated facility sketch.
2. Applicant submitted proof of TB test clearance for Manush Khodaverdian.
3. Manush Khodaverdian, tenant in the backyard has criminal record clearance in Licensing Information System.
4. Applicant has working telephone services in the home via cellphone that can stay in the home during daycare hours. (747) 202-5064.
5. Applicant added a child safety gate in backyard before main gate for additional safety.
6. Applicant submitted a declaration explaining the plan to use the detached garage for limited activity only. Per applicant, she will use the detached garage for limited activity only from 10:00 AM to 12:00PM and 2:30 PM-4:30PM. Per applicant, children will not eat and sleep in the detached garage.
7. LPA observed the fireplace in the living room was screened and inaccessible to the children.
8. Applicant covered the detached guests house heather outer vent facing outdoor playarea.
9. Fire clearance was granted on 12/21/23 to use the detached garage for limited activity only.


Exit interview conducted and report was reviewed with the applicant, Armine Kirakosyan at 9:30 AM.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2024
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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