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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494922
Report Date: 10/19/2021
Date Signed: 10/19/2021 11:40:18 AM

Document Has Been Signed on 10/19/2021 11:40 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:PETROSYAN FAMILY CHILD CAREFACILITY NUMBER:
197494922
ADMINISTRATOR:MELINE PETROSYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 645-0199
CITY:NORTHRIDGESTATE: CAZIP CODE:
91343
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
10/19/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Meline PetrosyanTIME COMPLETED:
11:45 AM
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On 10/19/2021 at 9:45 am, Licensing Program Analyst (LPA) Antonio Almanza and Licensing Program Manger (LPM) Mary Ruiz conducted a subsequent change of location Prelicesning Inspection and met with the applicant Meline Petrosyan who guided LPA and LPM on a tour of the home inside and out located at 16746 BAHAMA STREET, NORTHRIDGE CA 91343. The single-story home is a 1 bedroom, 1 bathroom ADU home. The Applicant is currently Licensed (fac 197493676) for a Large Family child Care License in the front home of the property located at 16748 BAHAMA STREET, NORTHRIDGE CA 91343.

The applicant is applying for a Large Family Child Care License to operate Monday through Saturday from 7:00 am to 7:00 pm and serve children ages 1 year to 12 years of age. The home is accessed on the left side of the property through a walk way through 2 gates.

Applicant states that she will be withdrawing her application. Licensee will continue to operate Large Familiy Child Care at 16748 BAHAMA STREET, NORTHRIDGE CA 91343 (fac 197493676)

An Exit Interview was conducted, and a copy of this report was provided to the applicant Meline Petrosyan.
SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2021
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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