197494828-5-4-2022-30-CC-SGAN-CE4PDS-20220504111400

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494828
Report Date: 05/04/2022
Date Signed: 05/04/2022 11:15:36 AM

Document Has Been Signed on 05/04/2022 11:15 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 CARE		FACILITY NUMBER:	197494828
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 3	DATE:	05/04/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Karine Grigoryan/Licensee		TIME COMPLETED:	11:20 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	Required-1 Year Visit Conducted In Armenian On 05/04/22 Licensing Program Analyst (LPA) Silva Garibyan, conducted an unannounced Required-1 Year Inspection and was met by Licensee, Karine Grigoryan. Days and hours of operation are Monday to Friday from 6:00 AM to 12:00 AM. LPA toured the home inside and outside and a census was taken. There are three preschool age children present at the time of the visit. All areas identified on the facility sketch were inspected. Licensee's home is a single story 3 bedroom, 1 bathroom home with living room, kitchen, laundry room. The main entry door will be used to enter the facility. Applicant's bedroom is off limits to the children in care. Children will eat and sleep in the living room and in two bedrooms. The attached unit on the property has different address ( the licensee provided the address for the attached unit: 8031 1/2 Van Noord Ave, North Hollywood, CA 91605). There is an in-ground pool on the premises located in the back yard of home with fencing around the perimeter. Pool was inspected and fence was measured by applicant during today’s visit. LPA observed the pool fencing to be 5 feet high. One side of the pool is enclosed by the iron fence. The iron fence has self latching gate that swings away from the pool and has a self latching device that is located no more than 6 inches from the top of the fence. The three sides are enclosed by the property walls. The iron fencing is sturdy and capable of withstanding the impact of children's toys including bicycles. There are no other bodies of water on the premises. Family members residing in the home include licensee only. Page 1 of 3.

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

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: 197494828
	VISIT DATE: 05/04/2022

NARRATIVE

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There is a working fire extinguisher, smoke detectors, carbon monoxide detectors and adequate heating and ventilation for safety and comfort. There are no stairs in this home. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (818) 939-8268.

There are currently no infants enrolled in care. LPA discussed Safe Sleep Regulations with licensee. Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained. LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee is Armenian speaking and the Mandated Reporter Training is not available in Armenian at the time of this inspection. Licensee’s pediatric CPR/First Aid expires on 04//23. A review of records indicates that Licensee has immunization records on file for influenza, pertussis and measles.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

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SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

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: 197494828
	VISIT DATE: 05/04/2022

NARRATIVE

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LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

LPAs advised Applicant to follow and remain updated with COVID-19 guidelines.
To access the guidance and the ECE Toolkit, please go to: http://ph.lacounty.gov/acd/ncorona2019/EducationToolkit/ECE/
Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

The licensee is applying for an increase of capacity; Large Family Child Care Home license for a maximum capacity of 14. The licensee has installed the pull fire alarm that is required for large Family Child Care Homes and has an approved fire clearance.

Capacity and Ratios: The licensee has applied for a capacity increase for a large family . The Maximum capacity is 12 with no more than 4 infants and a qualified assistant. Without a qualified assistant the license reverts back to the requirements for a small family childcare. Optional care may be provided for a maximum capacity of 14 children with no more then 3 infants, 2 school age children and a qualified assistant. School age children must be 1 age 6 yrs and 1 in

This report shall be made available to the public upon request. Appeal Rights, LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

LIC809 (FAS) - (06/04)

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