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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021508
Report Date: 09/15/2025
Date Signed: 09/15/2025 11:18:49 AM

Document Has Been Signed on 09/15/2025 11:18 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:DAVTYAN & SIRAKANYAN FAMILY CHILD CAREFACILITY NUMBER:
198021508
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
09/15/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Gohar Sirakanyan TIME VISIT/
INSPECTION COMPLETED:
11:45 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
Case Management Inspection -Conducted in Armenian

Licensing Program Analyst (LPA) Shushanik Safaryan conducted an unannounced case- management inspection to the above facility due to licensee is requesting capacity increase. LPA arrived to the facility at 8:45 am and met with, Gohar Sirakanyan, Licensee . Co-Licensee, Ruben Davtyan was not home . Per licensee , Co- licensee was out due to his birthday celebration .Licensee ,Gohar Sirakanyan guided analyst on a tour of the facility. Upon arrival, LPA observed 2 children in the home. During this inspection individuals who reside in the home were discussed and noted on Confidential Name List (LIC811) and attached to this report. Per licensee, facility hours are Monday to Sunday from 8:00 a.m. to 12:00 p.m. Licensee stated she will care for children from 0-13 years old.

For Large Family Child Care Home Fire Clearance was granted on 08/28/2025.

This is a one story home located on the first level. The home consists of 3 bedrooms, 2 bathrooms, living room, family room, dining room, kitchen, laundry room, detached garage, front yard, and backyard (fenced).
Per licensee, parents enter the home through the main entrance which leads to the living room(main day care area).
Areas that are accessible to children are as follows: Bathroom in the hallway adjacent to the kitchen, living room, family room, kitchen, dining room, laundry room, and back of backyard (fenced).
Page 1 of 5
NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Shushanik Safaryan
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2025
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 7
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)
Page: 2 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: DAVTYAN & SIRAKANYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021508
VISIT DATE: 09/15/2025
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
26
27
28
29
30
31
32
Areas off limits based on facility sketch submitted to children and parents include: Three bedrooms, one bathroom in the hallway of bedrooms, front yard, detached garage, and back yard (cement area and side yard ).

**Rooms that are off-limits need to be made inaccessible during operating hours*

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness.

At 9:00 am, the licensee began touring LPA through the home starting with the entry way which led directly to the living room (day-care area).In the day care area, LPA observed toys for children , small table and chairs. LPA observed all required postings on the living room wall . Next LPA toured the dining area and observed additional small tables and chairs. LPA observed door that leads to the hallway have a child safety latch to prevent children from entering to the two off limit bedrooms and off limit bathroom. Next LPA observed door leading to the kitchen . LPA observed child safety latch on the cabinets were sharp items stored. Children pass through the kitchen to go to the bathroom . LPA toured the bathroom and did not observe any hazards. LPA observed laundry machines next to the bathroom area. LPA observed detergents and cleaning supplies stored up high inaccessible to the children. Next LPA toured the family room and observed dining table , chairs , sofa. Per licensee children only use this area to exit to the outdoor play area and always supervised. From the family room , LPA observed door to the licensee`s bedroom. Licensee states the bedroom door is always locked.

Children use back yard for outdoor activities. LPA toured outdoor play area and observed cement area , fenced area for children to play. Licensee stated children pass through cement area and enter fenced area where LPA observed artificial grass , toys, play equipment. In the play area , LPA did not observe any hazards. LPA observed , detached garage used for storage area. Garage door was in cement area and locked.

LPA observed the required 2A 10BC fire extinguisher was anchored in the dining room with the purchase date 07/21/25. Smoke and Carbon Monoxide were observed in the dining room.

Page 2 of 5
NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Shushanik Safaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025
LIC809 (FAS) - (06/04)
Page: 4 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: DAVTYAN & SIRAKANYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021508
VISIT DATE: 09/15/2025
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
26
27
28
29
30
31
32
Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children.

Per licensee, she provides food for children in care. Licensee was advised that if food is brought from the children’s homes, all containers must be labeled with child’s name and properly stored or refrigerated.

Per Licensee, Gohar at 10:00 a.m. there are no pets, weapons, firearms, pools, spas, hot tubs, fishponds, or similar bodies of water on the premises.

The licensee was observed to be operating within the licensed capacity and is not exceeding the required limitations during this inspection. Per licensee she has only two children enrolled .During this inspection 2 children were present in the facility with licensee.


At 10:15 am , children’s records were reviewed, including emergency information, and were observed to be complete.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

The licensee completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expired on 08/2025. Co licensee Pediatric First Aid and CPR expires on 04/2026. Licensee completed required mandated reporter training on 10/19/2023. Co-Licensee completed required mandated reporter training on 04/2024.
Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com. The licensee and co-licensee have proof of immunization against influenza, pertussis, and measles.

There are first aid supplies available in the dining room. LPA advised licensee that if a child shows signs of illness, he/she/they shall be separated from other children.



Page 3 of 5
NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Shushanik Safaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025
LIC809 (FAS) - (06/04)
Page: 5 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: DAVTYAN & SIRAKANYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021508
VISIT DATE: 09/15/2025
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
26
27
28
29
30
31
32
Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted in the living room area.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family childcare facility.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home. There is telephone service via a cellphone that is used, and the cellphone stays at the facility during operation hours.



Per licensee, she does not carry liability insurance or a bond in accordance with standard established by Family Child Care statue.

INFANT CARE: Licensee states she does not have any infants enrolled at this time .



Medication: Incidental Medical Services (IMS) policy was discussed. The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. 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.

LPA advised the licensee to access forms, regulations and quarterly updates online at: www.ccld.ca.gov.

Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

Page 4 of 5

NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Shushanik Safaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025
LIC809 (FAS) - (06/04)
Page: 6 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: DAVTYAN & SIRAKANYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021508
VISIT DATE: 09/15/2025
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
26
27
28
29
30
31
32
LPA discussed all the deficiencies cited during today’s inspection with the licensee. Per licensee, she understands all the deficiencies and plan of correction .

The Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Licensee, Gohar Sirakanyan on 09/15/2025.

Page 5 of 5

NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Shushanik Safaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025
LIC809 (FAS) - (06/04)
Page: 7 of 7
Document Has Been Signed on 09/15/2025 11:18 AM - It Cannot Be Edited


Created By: Shushanik Safaryan On 09/15/2025 at 10:15 AM
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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: DAVTYAN & SIRAKANYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021508

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/29/2025
Section Cited
CCR
102416(c)

1
2
3
4
5
6
7
102416 Personnel Requirements:(c)The licensee and other personnel as specified shall complete training on preventive health practices, including pediatriccardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
This requirement not met evidenced by.
1
2
3
4
5
6
7
licensee satted she will obtain appointment and complete required training and submit to LPA by POC date .
8
9
10
11
12
13
14
During the file review , LPA observed licensee`s pediatric first aid cpr was expired on 08/2025. Co-licensee was not home during the visit .
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Brandi VanOosten
NAME OF LICENSING PROGRAM MANAGER:
Shushanik Safaryan
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2025


LIC809 (FAS) - (06/04)
Page: 3 of 7