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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197409052
Report Date: 05/21/2019
Date Signed: 05/21/2019 12:35:35 PM

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:GROZOV FAMILY CHILD CAREFACILITY NUMBER:
197409052
ADMINISTRATOR:GROZOV, EDITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 727-1255
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY:14CENSUS: 7DATE:
05/21/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Edita GrozovTIME COMPLETED:
11:30 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
Margarit Sislyan, Licensing Program Analyst (LPA) arrived at the facility to follow up with Exemption denial letter from CBCB.

LPA met with Licensee, Edita Grozov on 5/21/19 and toured the facility at 9:00 AM.

LPA observed 7 children were present at the facility along with licensee and her assistant.

LPA did not observe Victor Grozov at the facility.

LPA interviewed licensee and her assistant.

LPA informed licensee that the exemption request for Victor Grozov was denied and informed her that her license will be referred to the legal division for revocation. The revocation was based solely on the denied criminal record exemption.

Exit interview

SUPERVISOR'S NAME: Sharon GreeneTELEPHONE: (424) 302-3048
LICENSING EVALUATOR NAME: Margarit SislyanTELEPHONE: ((42) 430-3049
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019
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