<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700469
Report Date: 09/14/2022
Date Signed: 09/14/2022 06:46:40 PM

Document Has Been Signed on 09/14/2022 06:46 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:ARSHAKYAN FAMILY CHILD CAREFACILITY NUMBER:
197700469
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
09/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
05:01 PM
MET WITH:Anzhela ArshakyanTIME COMPLETED:
05:36 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 9/14/2022 LPA Isabel Ortega conducted a Case Management inspection to ensure RSO Edgar Dominguez is not residing at this facility home address. RSO was received at the Palmdale Regional office.

LPA met with Licensee Arshakyan and son who stated Edgar Dominguez does not live at this address nor do they know who this individual is. According to licensee and son they moved into this home address about two years ago.

LPA did not observed any other adult at this facility.

An exit interview was conducted, appeal rights, notice of site visit and copy not this report was provided to licensee.
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2022
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 1