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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494050
Report Date: 03/26/2021
Date Signed: 03/26/2021 08:50:35 AM

Document Has Been Signed on 03/26/2021 08:50 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:HAKOBYAN FAMILY CHILD CAREFACILITY NUMBER:
197494050
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
03/26/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
02:56 PM
MET WITH:Applicant - Karine HakobyanTIME COMPLETED:
03:05 PM
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On 03/26/2021 at 2:56pm Licensing Program Analyst (LPA) Ericka Hill contacted the Licensee to conduct a Pre-Licensing inspection for an Increase in Capacity request per the Licensee's request. LPA Hill informed the Licensee the purpose of the visit and proceeded with the inspection via tele-communication, due to COVID-19 restrictions.

Indoor areas:
Accessible: Living room/child care area and bathroom #1. During todays visit LPA observed 0 children being cared for. The child care area was clean, free of hazards, and provided age appropriate space and materials for the intended children (2 years+). Bathroom #1 was observed to be clean, free of hazards, and equipped with age-appropriate toiletries for children.

Inaccessible: Kitchen, bedroom #1, bedroom #2, and bathroom #2. LPA observed these areas to be separate and inaccessible to the children. LPA also observed bedroom #1, bedroom #2, and bathroom #2 to be clean, free of hazardous items. LPA observed the required documents on the Parent Board and First-aid Kit.

Outdoor Area:
LPA Hill observed age-appropriate toys, materials, and equipment for the children in care. The outdoor area was observed to be clean, free of hazardous materials, provided plenty of shade, and the bottom of the play equipment was cushioned to decrease injuries.

On the premises, LPA observed COVID-19 related procedures such as a thermometer, gloves, cleaning and disinfecting products, hand sanitizer, signs, masks, and social distancing practices.

An exit interview was conducted and a copy of this form (LIC809) was provided to the Licensee. LPA Hill requested the Licensee to read, sign, and email the the LIC809 back to LPA Hill.
SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Ericka Hill
LICENSING EVALUATOR SIGNATURE: DATE: 03/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2021
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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