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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494320
Report Date: 01/24/2020
Date Signed: 01/24/2020 10:05:46 AM

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 AND MNATSAKANYAN FAMILY CHILD CAREFACILITY NUMBER:
197494320
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
01/24/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Gor MnatsakanyanTIME COMPLETED:
10:15 AM
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On 1/24/2020 at 9:00 AM Licensing Program Analyst (LPA) Angelica Ramirez conducted an unannounced case management inspection for the purpose of a health and well-ness check. Upon arrival LPA observed two infants in care with two assistants, licensee Gor Mnatsakanyan also present. LPA met with licensee Gor and assistant Hripsime Manukyan provided translation due to licensee speaks primarily Armenian.

LPA observed a roster and children files, LPA obtained a copy of the roster. LPA conducted a tour of the facility with the licensee and assistant Manukyan inside and out.

There is a licensed facility on the same property with a different address 14628 La Maida St. The two facilities are separated by a fence and there is no access from one facility to the other, LPA verified.
LPA discussed with licensee hours of operation, daily activity schedule and adjacent facility. See LIC812 for details.

No deficiencies were observed or cited during today's inspection.
An exit interview was conducted, a copy of this report and notice of site visit were provided.
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Angelica RamirezTELEPHONE: (424) 301-3071
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020
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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