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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021370
Report Date: 06/17/2024
Date Signed: 06/17/2024 12:52:03 PM

Document Has Been Signed on 06/17/2024 12:52 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:KIRAKOSYAN FAMILY CHILD CAREFACILITY NUMBER:
198021370
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 7DATE:
06/17/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Armine Kirakosyan, LicenseeTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analyst (LPA), Anomeh Eivazian, conducted an unannounced case- management inspection to the above facility on 06/17/24 at 10:30 am. LPA met with Armine Kirakosyan, licensee who guided LPA on a tour of the facility. During this inspection there were total of seven children present in the facility with licensee and her two assistants.

During this inspection licensee's assistant, Gayane Gasparyan was present in the home who did not have criminal record clearance on file. Per licensee, Gayane Gasparyan has been working at this facility since May 2024. $500 Immediate civil penalty was assessed during this inspection.

During this inspection, licensee did not have facility roster available for review.

During this inspection seven children were present in the facility and licensee did not have seven children files available for review.

During this inspection licensee's assistants, Gayane Gasparyan and Roza Guseinova did not have TB test clearance on file.

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.



LPA Anomeh Eivazian informed licensee, Armine Kirakosyan that this report dated 06/17/24 document(s) 1 of Type A citation. Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.
REPORT CONTINUES ON NEXT PAGE 1 of 2
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2024
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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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: KIRAKOSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021370
VISIT DATE: 06/17/2024
NARRATIVE
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Also, LPA Anomeh Eivazian informed the licensee, Armine Kirakosyan to provide a copy of this licensing report dated 06/17/24. that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit 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, Armine Kirakosyan.


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

DATE: 06/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 06/17/2024 12:52 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 06/17/2024 at 10:25 AM
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: KIRAKOSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021370

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/18/2024
Section Cited
CCR
102370(d)(1)

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102370 (d) (1) Criminal Record Clearance - All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed ...
This requirement was not met as evidenced by ...
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Per licensee, Gayane Gasparyan will completed criminal record clearance today and will not be present in the facility until grant criminal record clearance.

$500 immediate civil penalty was assessed on this date.
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During this inspection licensee's assistant, Gayane Gasparyan was present in the facility, who has been working at this facility since May 2024 and did not have criminal record clearance on file. This poses an immediate health, safety and personal right risk to the children 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.
SUPERVISOR'S NAME:Christina Gabelman
LICENSING EVALUATOR NAME:Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:
DATE: 06/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/17/2024


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 06/17/2024 12:52 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 06/17/2024 at 10:42 AM
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: KIRAKOSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021370

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/05/2024
Section Cited
CCR
102417(g)(8)

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102417(g)(8)--Operation of A Family Child Care Home
Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
This requirement is not met as evidenced by:
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Per licensee, she will have her facility roster by 07/05/24 and a copy will be submitted to LPA via eamil.
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During this inspection facility roster was not available for review.

This poses a potential health, safety and personal right risk to the children in care.
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Type B
07/05/2024
Section Cited
CCR102369(b)9

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102369(b)9--Application for Initial License
Evidence of a current tuberculosis clearance, not more than one year prior to or seven days after initial presence in the home, for any adult in the home during the time that children are under
This requirement is not met as evidenced by:
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Per licensee, she will submit her two assistants TB Test clearance to LPA by 07/05/24.
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During this inspection licensee's two assistant, Gayane Gasparyan and Roza Guseinova did not have TB Test clearance on file.

This poses a potential health, safety and personal right risk to the children 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.
SUPERVISOR'S NAME:Christina Gabelman
LICENSING EVALUATOR NAME:Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:
DATE: 06/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/17/2024


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 06/17/2024 12:52 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 06/17/2024 at 11:04 AM
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: KIRAKOSYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021370

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/05/2024
Section Cited
CCR
102421(b)

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102421(b)--Child's Records
The licensee shall maintain, in each child's record, a copy of the emergency information card required in Section 102417(g)(7).

This requirement is not met as evidenced by...
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Per licensee, she will have 7 children files available by 07/05/24 and copies will be submitted to LPA via email.
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During this inspection 7 children were present in the home and licensee did not have 7 children file available for review.
This poses a potential health, safety and personal right risk to the children 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.
SUPERVISOR'S NAME:Christina Gabelman
LICENSING EVALUATOR NAME:Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:
DATE: 06/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/17/2024


LIC809 (FAS) - (06/04)
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