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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197403536
Report Date: 04/17/2024
Date Signed: 04/17/2024 04:37:25 PM

Document Has Been Signed on 04/17/2024 04:37 PM - 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:KUSHNATSIAN FAMILY DAY CAREFACILITY NUMBER:
197403536
ADMINISTRATOR/
DIRECTOR:		KUSHNATSIAN, SUSANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 366-6815
CITY:NORTHRIDGESTATE: CAZIP CODE:
91326
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
04/17/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Susan Kushnatsian, LicenseeTIME VISIT/
INSPECTION COMPLETED:
04:36 PM
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
On April 17, 2024 Licensing Program Analyst (LPA) Ortega met with Licensee, Susan Kushnatsian. The purpose of the inspection was to conduct an unannounced case management inspection -Other. According to Licensee she has decided to surrender her Family Care Care License effective 6/08/2024. At the time of arrival LPA observed two children in care and one staff providing care and supervision.

Licensee completed a declaration(on file) stating effective 6/08/2024 she will permanently closed her Large Family Child Care Home. and will surrender her license, Licensee is aware her original Family Child Care license shall be forward to Community Care Licensing Department at the Palmdale Regional office.

A copy of this report was reviewed with Licensee.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE: DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/17/2024
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