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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494828
Report Date: 05/06/2021
Date Signed: 06/24/2021 09:42:54 AM

Document Has Been Signed on 06/24/2021 09:42 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:GRIGORYAN FAMILY CHILD CAREFACILITY NUMBER:
197494828
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/06/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Karine Grigoryan/applicantTIME COMPLETED:
11:30 AM
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On 05/06/2021 at 10:00 AM Licensing Program Analyst (LPA) Silva Garibyan conducted an announced follow-up Pre-Licensing tele-inspection via FaceTime due to the COVID-19 pandemic shelter-in-place orders in the state of California. The purpose of the meeting was to ensure that health, safety and personal rights as required by Title 22 Regulations governing California Family Child Care homes will be met by the Licensee
LPA and applicant toured the facility to ensure the corrections were made as follows:

1) Pool gate shall swing away from the pool, self-close and have a self-latching device located no more than six inches from the top of the gate.
2) Revised LIC508 for applicant

LPA toured the backyard area to ensure that the pool fencing meets the Title 22 requirements. LPA observed the pool gate swings away from the pool, self-close and have a self-latching device located no more than six inches from the top of the gate.The pool fence meets Title 22 regulations.

Applicant provided a copy of her revised LIC508 ( original will be mailed to El Segundo Regional Office).

The facility is recommended for licensure at a Small capacity of 8 children.



An exit interview was conducted and a copy of this report will be provided via email to licensee. .
SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2021
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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