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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018532
Report Date: 07/19/2022
Date Signed: 07/19/2022 11:44:03 AM

Document Has Been Signed on 07/19/2022 11:44 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:PETROSYAN HOVSEPYAN FAMILY CHILD CAREFACILITY NUMBER:
198018532
ADMINISTRATOR:PETROSYAN, RIMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 500-0424
CITY:TUJUNGASTATE: CAZIP CODE:
91042
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
07/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:32 AM
MET WITH:Rima Petrosyan, LicenseeTIME COMPLETED:
12:03 PM
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On 7/19/22, Licensing Program Analyst (LPA) Liana Stepanyan conducted an unannounced comprehensive annual random site visit to ensure the health & safety standards as required by regulations governing family child care homes. LPA met with licensee, also present was helper and 12-day care children. Licensee has all appropriate forms posted. First Aid/CPR certificate is valid thru on 02/2023. LPA confirmed with licensee that all adults residing/working in the home have criminal record/TB clearances. Children’s records were reviewed and found to be in order. Licensee has practiced fire/emergency drills with daycare children on 03/15/22.

This 1 story, 3-bed, 3-bath home was toured, the following areas are used for daycare: living/dining/family room, bedroom #1/ bathroom, and front yard for outdoor play. Off limit areas include: master bedroom, hallway bathroom, bedroom #2, kitchen, laundry room and backyard. Drawers and lower cabinets in kitchen/bathroom are either latched or do not contain any hazardous items. There is an operational smoke alarm and fire extinguisher maintained in the home. The home has electrical outlet covers throughout and maintains a First Aid Kit in the main playroom. There are adequate age appropriate toys, books, games, and napping mats/hygienic diaper changing equipment. There are no firearms present on the premises as stated by licensee. Furthermore, there are no bodies of water. The outdoor play area is a fenced front yard, which is free of hazards and has sufficient toys. There are no pets present in the home. Per licensee, operating hours are from 7am-6pm, Monday thru Friday.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Liana Stepanyan
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2022
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: PETROSYAN HOVSEPYAN FAMILY CHILD CARE
FACILITY NUMBER: 198018532
VISIT DATE: 07/19/2022
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LPA reviewed the following: required departmental documents, regulation highlights, community resources, capacity limitations, supervision, clearances, emergency drills, heat-related illness, child passenger law, unusual incidents, mandated reporting, SIDS, Shaken Baby Syndrome, and Megan's law. Licensee is reminded that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats shall never be permitted during daycare operation.
For licensing regulations/updates/forms, go to webpage http://www.ccld.ca.gov

The facility is found to be incompliance with title 22. No deficiencies were cited during this visit.

An exit interview is conducted, copy of the report is review and provided to licensee along with notice of site visit.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Liana Stepanyan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022
LIC809 (FAS) - (06/04)
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