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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700462
Report Date: 10/08/2025
Date Signed: 10/08/2025 02:49:33 PM

Document Has Been Signed on 10/08/2025 02:49 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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:YERITSYAN FAMILY CHILD CAREFACILITY NUMBER:
197700462
ADMINISTRATOR/
DIRECTOR:		TATEVIK YERITSYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 530-8081
CITY:PORTER RANCHSTATE: CAZIP CODE:
91326
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
10/08/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:02 PM
MET WITH:Tatevik Yeritsyan; LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On Wednesday, October 8, 2025, Licensing Program Analyst (LPA) Hanna Cha met with licensee Tatevik Yeritsyan. The purpose of the visit was to conduct an unannounced Annual/Random inspection of the facility. Upon arrival, LPA disclosed the purpose of the inspection to the licensee. LPA and licensee toured the facility. During the inspection, LPA observed licensee and assistant providing care and supervision to one infant and eight preschool-aged children. The current days and hours of operation are Mondays through Fridays; 8:00am-9:00pm.

Physical Plant/Indoor/Childcare Area: This is a one-story single-family home. There is a living room, dining room, kitchen, three bedrooms, three restrooms, family room, a pool, a jacuzzi, car port, and side yard (utilized for the day care children) and a back yard (off limits). Main care is provided in the family room referred to as the children’s play area (separate entrance to the home). The child care area is separated from the main home by a child safety gate and door. The off-limit areas are the three bedrooms, two restrooms, living room, kitchen, dining room and the pool, and jacuzzi in the back yard (off limits)and the two sheds in the front patio utilized for equipment and storage (maintained pad locked).

Childcare Bathroom: The childcare bathroom (located bedroom #1) was observed to be in safe and operating condition. Toilet and faucet are in good operable condition. LPA reminded licensee to keep shampoos, mouthwash, razors, toothpaste, and other hazardous items inaccessible to all children.

NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Hanna Cha
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/08/2025
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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Document Has Been Signed on 10/08/2025 02:49 PM - It Cannot Be Edited


Created By: Hanna Cha On 10/08/2025 at 02:08 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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: YERITSYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700462

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/08/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.814(a)(1)(A)
Pool Safety
(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements: (1) The swimming pool shall be equipped with, at minimum, the following drowning prevention safety features: (A) An enclosure, including, but not limited to, a fence, wall, or other barrier that isolates the swimming pool from access to the family daycare home and has all of the following characteristics:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the pool and jacuzzi were not completely enclosed with fencing. There were two doors directly accessing the main home (off-limits areas), which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/22/2025
Plan of Correction
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Licensee will install additional fencing to ensure that pool and jacuzzi are completely enclosing with no allowance for doorways, windows, or other openings and email proof of completion to LPA Cha via email.
Type B
Section Cited
HSC
1596.814(a)(1)(B)(ii)(I)
Pool Safety
(ii) (I) An alarm that, when placed in a swimming pool, will sound upon detecting an entrance into the water. The alarm shall be turned on and be in working condition during a facility’s operating hours while the swimming pool is not in use.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, there was no pool alarm or pool cover for the swimming pool and jacuzzi in addition to fencing, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/22/2025
Plan of Correction
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Licensee will install pool alarms and send proof to LPA Cha via email by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Mariela Ramon
NAME OF LICENSING PROGRAM MANAGER:
Hanna Cha
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/08/2025


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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: YERITSYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700462
VISIT DATE: 10/08/2025
NARRATIVE
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Kitchen: The kitchen in the main home, made inaccessible from child care area with a child safety gate and door. Licensee participates in the food program and provides breakfast, lunch, and dinner. LPA inspected the kitchen for safety, sanitation, and good repair. Per LPA observation, knives are stored on kitchen counter. LPA reminded Licensee, if food is brought from the child’s home, the container shall be labeled with the child’s name and properly stored or refrigerated.

Outdoor/Children’s Play Area: Children utilize the side yard for outdoor play. LPA observed a white fence at 5 feet separating child care outdoor area from backyard. LPA inspected for safety, cleanliness, good repair, age-appropriate toys/equipment, and shady areas.

Pool/Bodies of Water: Per LPA observation there is a pool and jacuzzi located in back yard. LPA observed a gate measuring 5 ft accessed from the child care entrance gate. The opening of the gate swings away from the pool, self-closes, has a self-latching, key-lockable device. LPA observed an additional mesh fencing at 5 ft enclosing the pool, jacuzzi, and two locked doors that access the main home. The mesh fencing does not obscure the pool from view. LPA observed no climbing aids near the pool area. Licensee shall ensure the gate stays closed and locked at all times.

LPA informed licensee that additional mesh fencing must be installed to ensure that pool and jacuzzi are completely enclosed and does not allow any doorway, windows, or other openings to access pool and jacuzzi. Licensee will install additional fencing to prevent direct access to pool and jacuzzi from two doors from main home and provide proof of completion to LPA Cha via email by POC due date. A Type B citation issued. See 809-D.

Per LPA observation, there was no pool alarm or pool cover for the swimming pool and jacuzzi located in backyard of facility. Per licensee statement, licensee will install two ASTM approved pool alarms for swimming pool and jacuzzi. LPA informed licensee that pool alarms must be turned on and in working condition during all hours of operation. Licensee will install pool alarms and send proof to LPA Cha via email by POC due date. A Type B citation issued. See 809-D.
LPA observed a 12 foot rescue pole with a body hook. LPA did not observe a life ring with an exterior diameter of 24 inches approved by U.S. Coast Guard. Per licensee, life ring will be purchased and installed. Licensee will send proof of life ring purchase to LPA Cha via email. A Technical Violation issued.

NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Hanna Cha
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: YERITSYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700462
VISIT DATE: 10/08/2025
NARRATIVE
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LPA informed licensee the requirement for a daily swimming pool inspection log to ensure that daily pool checks are being conducted. LPA informed licensee that the swimming pool requirements will remain in place whenever licensed care is provided, and so long as the requirements make the swimming pool inaccessible to children as determined by the licensing department.

Other: First aid kit on premises. Per Licensee, there is no smoking in the home. Last disaster drill conducted on 08/2025. Electrical outlets made inaccessible. There is a working telephone (cell phone). Per licensee, there are no weapons/firearms on the premises.

File Review: LPA reviewed two children files which included required documents. LPA reviewed licensee’s file and assistant file which included all required documentation.


Licensee Pediatric CPR/FA expires on 06/2026. Licensee Mandated Reporter training expires on 09/2027.
Postings: Notice of Parent's Rights Poster (PUB 394), Facility License (LIC 203), Emergency Disaster Plan (LIC 610A)
Documents Provided: Entrance Checklist
To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Hanna Cha
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: YERITSYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700462
VISIT DATE: 10/08/2025
NARRATIVE
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Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. The Licensee shall permit the Department to inspect the family childcare home, and to privately interview children or staff, to determine compliance with or to prevent violations of family child care laws or regulations. Also, to enter and inspect any place providing personal care, supervision and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.

Licensee advised of the requirement to report Unusual Incidents. Licensee informed to utilize the Unusual Incident Report/Injury Report (LIC624B) when submitting a report to the department at: www.unusualincidentreport@dss.ca.gov. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven (7) days following the occurrence of any events specified above.
LPA discussed safe sleep regulations and the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee 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.
Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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: https://www.ada.gov/resources/child-care-centers/.
Licensee was informed of the MyChildCarePlan.org website; 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.
NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Hanna Cha
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: YERITSYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700462
VISIT DATE: 10/08/2025
NARRATIVE
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During the exit interview, licensee Tatevik Yeritsyan confirmed that there are no Registered Sex Offenders residing in the facility.

During this inspection, one Technical Violation and two Type B citations issued. See 809-D.

A Notice of Site Visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with licensee Tatevik Yeritsyan along with Appeal Rights.

NAME OF LICENSING PROGRAM MANAGER: Mariela Ramon
NAME OF LICENSING PROGRAM ANALYST: Hanna Cha
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025
LIC809 (FAS) - (06/04)
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