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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021480
Report Date: 06/18/2024
Date Signed: 06/18/2024 09:37:20 AM

Document Has Been Signed on 06/18/2024 09:37 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:ARMENAKYAN FAMILY CHILD CAREFACILITY NUMBER:
198021480
ADMINISTRATOR/
DIRECTOR:
FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/18/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Arsen Armenakyan, ApplicantTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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
PRELICENSING INSPECTION CONDUCTED IN ARMENIAN
Licensing Program Analyst (LPA) Anomeh Eivazian conducted an announced pre-licensing follow up inspection to the above facility on 06/18/24. LPA arrived at the facility at 8:40 AM and met with Arsen Armenakyan, Applicant who guided analyst on a tour of the facility. Also, Karine Armenakyan, applicant's wife was present in the home. Per applicant operation hours will be Monday to Friday, 7:30 a.m. to 5:30 p.m.. Applicant states he will care for children 1-13 years old.

The following corrections were observed during this inspection:
1. Applicant submitted an updated Application form LIC 279 to reflect all adults residing in the home.
2. Applicant submitted TB test clearance for himself and Armineh Armenakyan.
3. Applicant submitted Criminal Record Clearance transfer form LIC 9182 for Armineh Armenakyan.
4. Applicant submitted a declaration that he will be present in the home during daycare operation hours and does not have outside employment.
5. Applicant has a telephone services available in the home via cellphone which will stay in the home during daycare hours. (818)484-6277.
6. Applicant submitted an updated Facility Sketch LIC 999, Floor plan and Yard Plan.
7. There is a required 2A10BC fire extinguisher available in the home, anchored to the wall in the kitchen. It was serviced on 06/17/24 as read by LPA from service tag.
8. LPA observed the side yard gate has a operable self closing latch out of read of children.
9. Applicant submitted copy of CA ID to reflect this facility address on the ID.
10. LPA observed applicant removed Aloe Veras from side yard.
11. LPA observed applicant installed a gate in the side yard which leads to the backyard to make the backyard inaccessible to the children.

Exit interview conducted and report was reviewed with the applicant, Arsen Armenakyan.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2024
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