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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493473
Report Date: 01/09/2020
Date Signed: 01/09/2020 12:49:04 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:GRIGORYAN FAMILY CHILD CAREFACILITY NUMBER:
197493473
ADMINISTRATOR:GRIGORYAN, SHUSHANIKFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 307-6872
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91403
CAPACITY:14CENSUS: 10DATE:
01/09/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Shushanik GrigoryanTIME COMPLETED:
01:05 PM
NARRATIVE
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On 1/9/2020 at 12:00 PM Licensing Program Analysts (LPAs) Angelica Ramirez and Antonio Almanza were at the licensed facility conducting an alternate inspection when the deficiencies listed below were observed. LPAs observed 10 children in care, four infants and six toddlers being supervised by three assistants, one of whom does not have a criminal record clearance.

Deficiencies observed:
At 9:20 AM licensee's assistant (Staff #1) was observed by LPAs providing care to day care children without a criminal record clearance. After obtaining statements from facility staff members and licensee, it was determined that Staff #1 was at the facility on 1/8/2020 from 7:30 AM to approximately 5:00 PM and again on 1/9/2020 from 7:30 AM until the time of this report. This will result in a Type A citation, see LIC809-D. A civil penalty will also be issued.

At 9:20 AM LPAs observed licensee and staff providing care to six infants and six toddlers. This will result in a Type A citation.
LPAs observed Child #10 picked up by family friend at 11:37 AM and Child #6 was picked up by grandparent at 11:43 AM. As of this time, facility is now within ratio.

Type A deficiencies were cited during today's inspection (see LIC 809Ds). Each report (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit (printed out during this inspection).

**In addition; A copy of this report must be provided to the authorized representatives of all currently enrolled children and any newly enrolled child for the following 12 months.
The ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC9224) shall be signed and kept in each of the children’s records. The report shall be provided no later than the next business day or the next day the child is in care.

SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Angelica RamirezTELEPHONE: (424) 301-3071
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: GRIGORYAN FAMILY CHILD CARE
FACILITY NUMBER: 197493473
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/10/2020
Section Cited

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Criminal Record Clearance. (d) All individuals subject to a criminal record review... shall prior to working... in a licensed facility: ( 1) Obtain a California clearance or a criminal record exemption... This
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requirement was not met as evidenced by: based on licensee's statement and LPAs observation, the licensee did not obtain a criminal record clearance for Staff #1 prior to working at the facility. This poses an immediate health and safety risk to children in care.
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and the paid receipt via email to the department.
Type A
01/10/2020
Section Cited

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Staffing Ratio and Capacity. (b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home,
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shall be one of the following: (1) Four infants. This requirement was not met as evidenced by: based on LPA observation, the licensee had six infants and six toddlers present during today's inspection. This poses an immediate health and safety risk to children in care.
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declaration regarding how she intends to ensure she is no longer out of ratio by 1/10/2020.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Angelica RamirezTELEPHONE: (424) 301-3071
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2020
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GRIGORYAN FAMILY CHILD CARE
FACILITY NUMBER: 197493473
VISIT DATE: 01/09/2020
NARRATIVE
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Exit interview conducted with Licensee. A copy of this report, notice of site inspection, Appeal Rights (LIC 9058), Confidential Names List (LIC 811) were given and explained during this inspection.
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Angelica RamirezTELEPHONE: (424) 301-3071
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020
LIC809 (FAS) - (06/04)
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