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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700905
Report Date: 01/16/2025
Date Signed: 01/16/2025 11:47:59 AM

Document Has Been Signed on 01/16/2025 11:47 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:MIKAYELYAN FAMILY CHILD CAREFACILITY NUMBER:
197700905
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
01/16/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Nelli Mikayelyan, ApplicantTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On 1/17/2024 Licensing Program Analyst (LPA) Isabel Ortega conducted an announced pre-licensing inspection for the purpose of conducting a pre-licensing inspection for a Family Childcare with a capacity of eight children. LPA was greeted by applicant, who guided the LPA on a tour of the facility.

Applicant will operate Monday through Saturday from 7:00 am to 11:00 p.m. The Applicant will provide breakfast, lunch, afternoon snack and dinner as needed and plans to participate in the Food Nutrition Program (provided food program information).



This is a one-story single-family home. There is a living room, dining room, kitchen, three bedrooms, two restrooms, laundry room, a back yard, and in the back yard (utilized for storage and equipment). Main care will be provided in the living room and dining room referred to as the children’s play area. The off-limits areas are bedroom #1, #2, #3(child safety knob). The second restroom near the master bedroom is also off limits.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE: DATE: 12/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/31/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MIKAYELYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700905
VISIT DATE: 01/16/2025
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Children will utilize the restroom located to the left from the main entrance of the home.

The home was inspected inside and out for safety, comfort, cleanliness, service, heating, and center air ventilation. The home has age-appropriate toys, play equipment and materials. Applicant stores sharp knives in the kitchen cabinet (LPA observed a child safety gate), medication is stored inaccessible to children. Cleaning supplies are not accessible to children (maintained in the bottom of the laundry room).

Applicant has a complete Emergency First Aid Kit with a thermometer in the home, which is stored inaccessible to children. Children will be provided with cots during naptime and infants will be provided with a playpen. The backyard will be utilized for outdoor play and is gated all around and enclosed.

Applicant was reminded about always ensuring proper care and visual supervision.

LPA observed a fire extinguisher (2A10BC) that meets the State Fire Marshal standards (reading in green serviced 2/29/24). Applicant tested the smoke detector and carbon monoxide detector, and they were found to be in operable condition.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MIKAYELYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700905
VISIT DATE: 01/16/2025
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 Per applicant, there are no weapons or firearms in the home, nor did LPA observe any weapons or firearms during the inspection. Also, there are no bodies of water on the premises.

The applicant’s Pediatric CPR/First Aid expires on 09/28/2026. The applicant had the required immunizations against pertussis (Tdap), measles (MMR), and tuberculosis (TB). Family Childcare Orientation was completed on 10/12/2018. Preventative Health and Safety training with lead and nutrition component is dated 12/14/2024. Childcare Provider Mandated Reporter training (AB1207) is dated 8/30/2023.

Licensee will have the parent board and other Licensing required forms at the entrance of the day care area, visible to parents.

The following was discussed with applicants:
Infant safe sleep PIN, Infant Safe Sleep Plan (LIC9227) and safe sleep log were provided.

Mandatory licensing forms for the children’s files, facility forms/records, and information to be posted in the family child care home; Requirements to conduct fire and disaster drills once every six months and
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MIKAYELYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700905
VISIT DATE: 01/16/2025
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record it; Role and responsibilities of being a mandated reporter were reviewed; Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care; Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified; Regulation prohibits the smoking of any kind in the family child care home.

The Applicant was informed that all adults living in or having access to the home, or employees are required to have fingerprint clearances with Department of Justice, FBI and Child Abuse Central Index prior to having contact or working with children. If the aforementioned is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately. Please advise your analyst of any person who will be visiting regularly or for longer than one week. The applicant was advised to utilize the Request for Live Scan Service form LIC9163 to have adults fingerprinted and associated to the home.



The Applicant was advised of the requirement to report Unusual Incidents. 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.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MIKAYELYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700905
VISIT DATE: 01/16/2025
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 In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The applicant was informed to utilize the Unusual Incident Report/Injury Report form LIC624B when submitting the report to the department.

The Applicant was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months and licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian and place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports (LIC 9224). If these requirements are not met civil penalties per violation will be assessed.

Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors and employees to complete training as
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MIKAYELYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700905
VISIT DATE: 01/16/2025
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specified on their mandated reporter duties and to renew their training every two years. Applicants must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com. This Child Care Provider (AB1207) certificate is valid for two years and it is required to renew every two years.

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



The licensee was advised it is her responsibility to visit the department's website to access licensing forms, Quarterly Updates and Provider Information Notices (PINs): www.ccld.ca.gov
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MIKAYELYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700905
VISIT DATE: 01/16/2025
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Child Care Advocates:
To sign up for our Quarterly Updates and Provider Information Notices (PINs), please subscribe online: http://www.cdss.ca.gov/inforesources/Community-Care-Licensing/subscribe

The following was discussed with applicant: All licensing forms required in children's files; All licensing forms required in the facility; All licensing forms to be posted in the home; Fire and Disaster Drill log; California Car Seat Flyer; Safe Sleep Flyer; Parent Notification Requirements; and Safe Sleep-in Child-Care brochure; and additional resources for the applicant and her Family Child Care Home.



Applicant is ready for licensure; applicant has met Title 22 regulations for a Small Family Childcare Home License with a childcare capacity of 8 children which will be granted today 1/17/2025.

An exit interview was conducted, and a copy of this report was provided to applicant. All Licensing reports are recommended to be kept for a minimum three years.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
LIC809 (FAS) - (06/04)
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