198022079-5-8-2026-33-CC-AEIN-DTVU4E-20260508151502

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198022079
Report Date: 05/08/2026
Date Signed: 05/08/2026 03:15:26 PM

Document Has Been Signed on 05/08/2026 03:15 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 CARE		FACILITY NUMBER:	198022079
ADMINISTRATOR/ DIRECTOR:	KHACHATRYAN, KAREN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(747) 302-0202
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91201
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 1	DATE:	05/08/2026
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:00 PM
MET WITH:	Karen Khachatryan, Applicant		TIME VISIT/ INSPECTION COMPLETED:	03:30 PM

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PRELICENSING INSPECTION CONDUCTED IN ARMENIAN

On 05/08/26, at 12:00 PM Licensing Program Analyst (LPA) Anomeh Eivazian conducted an announced pre-licensing inspection to the above facility. LPA arrived at the facility and met with Karen Khachatryan, Applicant who guided analyst on a tour of the facility. During this inspection applicant’s wife, Roza Nazeyan, applicant’s mother in-law, Alvard Hovsepyan, and applicant’s biological child were present in the home. Pre-licensing Entrance Checklist (LIC9280) was provided to applicant, Karen Khachatryan. During this inspection individuals who reside in the home were discussed and notes on Confidential Name List (LIC811) and attached to this report. Per applicant operation hours will be Monday to Friday, 6:00a.m. to 11:30 p.m.. Applicant states he will care for children 0-14 years old.

Applicant previously was licensed at 1116 Irving Avenue, Glendale, CA 91201, with facility number 198021364.

Fire clearance for Large Family Child Care Home was granted on 04/17/26.

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, 1 and 1/2 restrooms, living room, dining room, kitchen, detached garage, storage in the backyard, front yard, and backyard (fenced). Per applicant, parents will enter the facility through the side gate which leads to the backyard and daycare area or main entrance which leads to the living room.

Areas that are accessible to children are as follows: Half Bathroom in the kitchen, dining room, living room, one bedroom adjacent to the backyard, kitchen, play areas in the backyard.

REPORT CONTINUES ON NEXT PAGE 1 of 7

NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026

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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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: 198022079
	VISIT DATE: 05/08/2026

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Areas off limits based on facility sketch submitted to children and parents include: Two bedrooms, one-bathroom, front yard, detached garage, storage in the backyard, and off-limit areas in the backyard.
**Rooms that are off-limits need to be made inaccessible during operating hours**
The applicant does understand that licensing staff may have access to off-limit areas during inspection if necessary.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. At 12:15 p.m., the applicant began touring LPA’s through the home starting with the entry way which led directly to the living room. The living room and dining room were inspected, and electrical outlets were observed to be covered. There is a fireplace in the living room which has been blocked off by book self to prevent access. The dining room and living room were inspected and LPA observed children tables, chairs, toys and a piano in the dining room and living room. Next the kitchen was inspected, and LPA observed child proof safety latches on the cabinets where applicant stores cleaning compounds and sharp items. Per applicant, children walk through the kitchen to go to the daycare area and backyard. Next LPA toured the half bathroom adjacent to the kitchen and did not observe any hazards. Next LPA toured the daycare bedroom adjacent to the backyard (day care play area) and observed children napping cots and toys in the bedroom. There is door in the bedroom (daycare play area) which leads to the backyard. Next LPA toured the two off-limit bedrooms and one off-limit bathroom in the hallway and did not observe any hazards. LPA observed a sliding gate was installed to the hallway to make the off-limit areas inaccessible to the children. LPA observed licensee's family personal belongings in the home. Per applicant no poisons are kept in the home. LPA observed the required 2A 10BC fire extinguisher was placed on the floor in the kitchen. It was purchased on 02/14/26 as read by LPA from the receipt. Applicant tested the carbon monoxide and smoke detectors in the dining room. It sounded off the alarms and heard by LPA to be functional. Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children.

Next LPA toured the backyard fenced. Per applicant, children will use the gated playarea in the backyard for outdoor play time. LPA observed off-limit areas in the backyard is gated to prevent access of the children to off-limit areas. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that can pose a danger to children on the outdoor yard. The applicant states that supervision is always provided. Next LPA toured the off-limit detached garage and storage in the backyard and did not observe any hazards. Per applicant, garage and storage doors are kept closed and locked all the times during daycare hours.

REPORT CONTINUES ON NEXT PAGE 2 of 7

NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026

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: KHACHATRYAN FAMILY CHILD CARE	FACILITY NUMBER: 198022079
	VISIT DATE: 05/08/2026

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APPLICANT RENTS/LEASES THE HOME: The applicant, Karen Khachatryan provided proof of control of property. Applicant confirmed that LIC 9149 was signed by landlord.

APPLICANT RENTS/LEASES THE HOME AND HAS LANDLORD CONSENT: Because the applicant, Karen Khachatryan rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

The applicant states that he will provide food for children in care. Applicant was advised that if food is brought from the children’s homes, all containers must be labeled with child’s name and properly stored or refrigerated. Per applicant, at 1:10 p.m., there are no pets, weapons, firearms or bodies of water on the premises. There are toys available for children. There is telephone service via a cellphone that is used and the cellphone stays at the facility during operation hours. LPA advised applicant that if a child shows signs of illness he/she/they shall be separated from other children. Per applicant no one smokes in the home. There are first aid kit in the home, in the kitchen. Per applicant, he will provide transportation.

Applicant has proof of CPR and First Aid training as indicated on the certificate. The applicant does have proof of Health and Safety training (completion date: 10/13/23), Pediatric First Aid and CPR (ex. 04/27). The applicant has proof of immunization against influenza, pertussis, and measles.

Applicant completed required mandated reporter training on 02/13/26. Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com

The following was discussed with the applicant:

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

-In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.

REPORT CONTINUES ON NEXT PAGE 3 of 7

NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026

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: KHACHATRYAN FAMILY CHILD CARE	FACILITY NUMBER: 198022079
	VISIT DATE: 05/08/2026

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-A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
-Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License shall be terminated.
-The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should check and batteries replaced as needed.
-Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
-Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report)
-Fire and safety drills must be performed every six months and documented for review by the Department.
-Smoking is prohibited in a family child care home.
-Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
-Dog(s) and or pets are recommended to be isolated from children in care.
-No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.
-All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
- Applicant shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.
- Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.

INFANT CARE: Applicant states that he will care for infants. Applicant states that infants will sleep in the living room, dining room and one daycare bedroom where they are constantly supervised. LPA advised the Applicant that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. A copy of the LIC 9227 was provided to Applicant.

REPORT CONTINUES ON NEXT PAGE 4 of 7

NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026

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: KHACHATRYAN FAMILY CHILD CARE	FACILITY NUMBER: 198022079
	VISIT DATE: 05/08/2026

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SAFE SLEEP: LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Medication: Incidental Medical Services (IMS) policy was discussed .For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Per applicant, there are no dual licenses at this address. Applicant’s email address was obtained during this inspection. The applicant was advised that email may be public information.

Per applicant, he does carries liability insurance in accordance with standard established by Family Child Care statue. The law requires Family Child Care provider to carry liability insurance or bond in the amount of $300,000 annually or to maintain the signed statement in the facility file.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

REPORT CONTINUES ON NEXT PAGE 5 of 7

NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026

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: KHACHATRYAN FAMILY CHILD CARE	FACILITY NUMBER: 198022079
	VISIT DATE: 05/08/2026

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Megan’s Law - Family Child Care Homes On this date, 02/19/26, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

MyChildCarePlan.org--Child Care Centers and Family Child Care Home Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Provider must reside in the home where care is being provided:

Definitions--102352 -- "Family Day Care" or "Family Child Care" means regularly provided care, protection and supervision of children, in the care giver's own home, for periods of less than 24 hours per day, while the parents or authorized representatives are away. The term "Family Child Care" supersedes the term "Family Day Care" as used in previous regulations and "Home" means the licensee's residence as defined by Government Code Section 244.

Provider must be present 80% of the time providing care as stated in the following regulation:

Operation of a Family Child Care Home--102417 (a)-- The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

Reporting Requirements--102416.2 (a) (2)--Any change in household composition including adults moving in or out of the home and anyone living in the home who reaches his or her 18th birthday.

Applicant's wife also Family Child Care Home Provider with facility number 198022078 located at 1339 Highland Avenue, Glendale, CA 91202. Per applicant, he and her wife will fully operate separately.

REPORT CONTINUES ON NEXT PAGE 6 of 7

NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026

LIC809 (FAS) - (06/04)

Page: 7 of 8

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: 198022079
	VISIT DATE: 05/08/2026

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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.

- Applicant will also have current children Rosters and children's files for enrollment.

- Applicant stated he resides at this address and does not have other resident. A written declaration was submitted to LPA.

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.

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, Karen Khachatryan.

REPORT END 7 of 7

NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026

LIC809 (FAS) - (06/04)

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