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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021539
Report Date: 10/06/2025
Date Signed: 10/06/2025 02:16:47 PM

Document Has Been Signed on 10/06/2025 02:16 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:
198021539
ADMINISTRATOR/
DIRECTOR:		KHACHATRYAN, SUSANNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 966-4442
CITY:GLENDALESTATE: CAZIP CODE:
91202
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 14DATE:
10/06/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Susanna Khachatryan, LicenseeTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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PLAN OF CORRECTION INSPECTION WAS CONDUCTED IN ARMENIAN
Licensing Program Analyst, Anomeh Eivazian conducted an unannounced Plan of Correction (POC) inspection to the above facility on 10/06/25 to ensure Type B deficiencies cited on 09/12/25 has been cleared. LPA arrived at 1:00 PM to the facility address. Upon LPA's arrival to the facility the main entrance door was wide open and LPA observed children were napping in the living room. LPA knocked on the door while standing in the door frame and did not enter inside the home, and Adana Khachatryan, licensee's daughter came to the door. LPA introduced herself and asked for licensee. Licensee's daughter, Adana Khachatryan asked LPA to step back to close the door to get the licensee. LPA asked Adana Khachatryan to leave the door open and call the licensee while LPA was standing in the door frame. LPA did not enter inside the home, licensee, Susanna Khachatryan came to the main entrance from backyard. Licensee, Susanna Khachatryan guided analyst on a tour of the facility. Also present during this inspection was Arusyak Movsisyan, assistant and Mnatsakan Khachatryan, licensee's husband. At 1:00 PM LPA observed 8 children were napping inside the home in the living room and 5 children were playing in the backyard. Upon LPA's arrival licensee's daughter, Adana Khachatryan left the home.

During this inspection total of 14 children were present in the home, aging 2-5 years old, 8 children were napping inside the home in the living room and 5 children were playing in the backyard. The licensee was observed not to be operating within the licensed capacity and is exceeding the required limitations with two children during this inspection. During this inspection licensee, also did not have current facility roster.
REPORT CONTINUES ON NEXT PAGE 1 of 2
NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2025
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 5
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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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: KHACHATRYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021539
VISIT DATE: 10/06/2025
NARRATIVE
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The following has been observed:

- Per licensee, currently she uses the entire backyard for outdoor playtime. Per licensee, if there should be any changes in the daycare area licensee will inform the department.


- LPA observed proof of immunization against measles and pertussis on current licensee's assistances, Arusyak Movsisyan, Nona Simonyan and Sona Msryan files.

LPA cleared one Type B deficiencies on this date and provided a copy of the Licensing Report to licensee and issued POC clearance letter.
The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809D for deficiencies that are being cited and need to be cleared to protect the children’s health & safety.

LPA Eivazian informed licensee, Susanna Khachatryan that this report dated 10/06/25 documents 1 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.

Also, LPA Eivazian informed the licensee, Susanna Khachatryan to provide a copy of this licensing report dated 10/08/25 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

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, Susanna Khachatryan.


REPORT END 2 of 2
NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 10/06/2025 02:16 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 10/06/2025 at 01:33 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: 198021539

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/07/2025
Section Cited
CCR
102416.5(a)

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102416.5 Staffing Ratio and Capacity
(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.
This requirement was not met as evidenced by...
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Per licensee, she will disenroll two children from her daycare effective today and an updated facility roster will be sent to LPA by 10/07/25.
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Upon LPA's arrival to the facility LPA observed 14 children were present in the facility, aging 2-5 years old with licensee and her assistant. Licensee was out of her license limitation with 2 children.
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.
Christina Gabelman
NAME OF LICENSING PROGRAM MANAGER:
Anomeh Eivazian
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/06/2025


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 10/06/2025 02:16 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 10/06/2025 at 01:39 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: 198021539

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/11/2025
Section Cited
CCR
102417(8)

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Operation of a Family Child Care Home
102417(8)--Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
This requirement was not met as evidenced by...
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Per licensee, she will have her current facility roster by 10/11/25.
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During this inspection licensee did not have her current children facility roster.
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.
Christina Gabelman
NAME OF LICENSING PROGRAM MANAGER:
Anomeh Eivazian
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/06/2025


LIC809 (FAS) - (06/04)
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