198022105-4-27-2026-33-CC-SSAN-DTJRX3-20260427132406

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198022105
Report Date: 04/27/2026
Date Signed: 04/27/2026 01:24:18 PM

Document Has Been Signed on 04/27/2026 01:24 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	KISHMISHYAN FAMILY CHILD CARE		FACILITY NUMBER:	198022105
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	04/27/2026
TYPE OF VISIT:	Office	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:00 PM
MET WITH:	Sargis KIshmishyan		TIME VISIT/ INSPECTION COMPLETED:	01:45 PM

NARRATIVE

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An office meeting was held today to discuss the pending application for a Family Child Care Home license and the information provided during the application process. The role of Anahit Kishmishyan was discussed, along with clarification regarding the declaration submitted to the Department by email on April 8, 2026, concerning the applicant and licensee Shushanik Ghazaryan.

For confidentiality and to avoid potential conflicts, the department can only discuss the application and licensed facility with Sargis Kishmishyan once it is licensed.

Present during the meeting were Brandi Van Oosten, Licensing Program Manager (LPM); Shushanik Safaryan, Licensing Program Analyst (LPA); applicant Sargis Kishmishyan; and the applicant’s daughter, Anahit Kishmishyan.

Sargis Kishmishyan was licensed in Burbank effective 12/5/2024 and is requesting a location change to obtain a family child care license at 529 W LEXINGTON DR, Glendale, CA 91203.

Licensee`s daughter Anahit Kishmishyan has a license under facility number 198021950, address: 1345 WINCHESTER STREET, Glendale, CA 91201.

Licensee`s ex-wife, Shushanik Ghazaryan, has a license 198020457, address: 411 CHESTER ST. Glendale, CA 91203.

During this visit, the following items were discussed:

Definitions – 102352
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NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Shushanik Safaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026

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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KISHMISHYAN FAMILY CHILD CARE	FACILITY NUMBER: 198022105
	VISIT DATE: 04/27/2026

NARRATIVE

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“Family Day Care” or “Family Child Care” refers to the regular provision of care, protection, and supervision of children in the caregiver’s own home for periods of less than 24 hours per day while parents or authorized representatives are away. The term “Family Child Care” replaces “Family Day Care” as used in previous regulations. “Home” means the licensee’s residence as defined in Government Code Section 244.

Provider Presence Requirement
The provider must be present at least 80% of the time while care is being provided, 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, the licensee must arrange for a substitute adult to care for and supervise the children during the absence. Temporary absences shall not exceed 20% of the facility’s daily operating hours.

Reporting Requirements – 102416.2(a)(2)
Any change in household composition must be reported, including adults moving into or out of the home, and any individual living in the home who turns 18 years old.

Inspection Authority of the Department – 102391(a)
Any duly authorized officer, employee, or agent of the Department may, upon presentation of proper identification, enter and inspect any location providing personal care, supervision, and services at any time, with or without advance notice, to ensure compliance with regulations governing family child care homes and in accordance with Section 102396.

During this meeting, the applicant was informed that once a license is issued, the licensee must operate separately from any other provider, regardless of family relationships, and that enrolled children must remain at the licensed facility during daycare hours. Parents of enrolled children must be fully informed of, and clearly understand, who the licensee and caregiver are for the children in care.

Children may not move between licensed facilities during daycare hours, and children enrolled under separate licenses may not be co-mingled.

Per applicant, he will submit corrected declaration by end of this week. Applicant also stated they understand regulations stated on the report.

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NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Shushanik Safaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026

LIC809 (FAS) - (06/04)

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