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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700274
Report Date: 05/14/2024
Date Signed: 05/14/2024 03:34:48 PM

Document Has Been Signed on 05/14/2024 03:34 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:GRIGORYAN FAMILY CHILD CAREFACILITY NUMBER:
195700274
ADMINISTRATOR/
DIRECTOR:		MARIAM GRIGORYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(747) 203-4937
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91403
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
05/14/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Applicant / Mariam GrigoryanTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 5/14/24, at 11:15AM, Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an announced Pre-Licensing Inspection. The purpose of the visit 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 Applicant. This is a change of location for a Large Family Child Care Home, for a Capacity of 14 children - ages 0 months to 17 years of age. The family child care home will operate Monday through Friday, 7:30AM to 5:30PM. Upon arrival, LPA met with Applicant / Mariam Grigoryan, who guided LPA on a tour of the inside and outside of the home. LPA observed no children in care. At the time of visit, the applicant confirmed that she is currently not residing in the home until the application is approved. Applicant is currently licensed and is residing in Sherman Oaks, CA (#197493505).

Per facility sketch and tour of the home, the following was observed and discussed with the Applicant during the inspection:


Home is a 1-story dwelling that consists of a living room, play room, kitchen, 2 bedrooms, 2 bathrooms and a laundry room. LPA observed the following:

· The living room is on limits and will be used for child care activities. The living room has a fireplace which has been barricaded by a storage shelf to prevent access by children. Per Applicant, the fireplace will not be used. Electrical outlets have safety covers installed.
· The play room is on limits and will be used for child care activities. Electrical outlets have safety covers installed. The play room will be used when leading children to the side yard / patio area.
· The kitchen is off limits and made inaccessible by the use of a baby gate. Hazardous materials and sharp objects are made inaccessible to children.
· Bedroom 1 is on limits and will be used for napping. LPA observed 1 play yard and 2 cots in place. Per Applicant, additional beds for infants will be purchased upon admission. This room will also be used as an isolation area as needed.
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Joe Katrdzhyan
LICENSING EVALUATOR SIGNATURE: DATE: 05/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/14/2024
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GRIGORYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700274
VISIT DATE: 05/14/2024
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· Bedroom 2 is off limits and made inaccessible by the use of a door with a lock and also a child safety mechanism.
· Bathroom 1 is off limits and made inaccessible by the use of a door with a lock and also a child safety mechanism.
· Bathroom 1 is on limits to children in care.
· The laundry room is off limits. The laundry room is located next to the kitchen and is made inaccessible by the use of a baby gate located by the entrance of the kitchen.
· The Backyard is off limits and made inaccessible by the use of a gate, located on the side of the property, near the gas meter and also by a white vinyl gate, located near the side yard / patio area.
· The Front yard is on limits and will be used for children to enter the home. The front yard is completely enclosed and will be used as a play area for children in care.
· The side yard / patio area is on limits and will be used for child care activities. Children will access the side yard / patio area by using the sliding doors through the play room.
· The applicant states that they will provide breakfast, lunch, dinner and snacks for children in care.
· The facility is equipped with video surveillance (outside only).

The home has a separate structure (a 2 story home / ADU) located on the back of the property, which has a separate address (4842 Vista Del Monte Ave, Sherman Oaks, CA 91403). Per Applicant, the individual(s) that reside in the back home do not have access to the child care home and will have no contact with children in care. LPA observed a locked metal gate in the back of the child care home, along with white vinyl fencing separating the back home from the child care home. Per Applicant, individual(s) residing in the back home use a separate entrance/exit for access to the back home, which is through the back alley. Entrance to the back alley is through Huston St. The Applicant provided a copy of the approved building permit (from City of Los Angeles) regarding the back home / ADU.
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Joe Katrdzhyan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GRIGORYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700274
VISIT DATE: 05/14/2024
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The following was also observed by LPA Katrdzhyan during the inspection:
1. All adults living in the home have submitted fingerprints and child abuse index check forms to Department of Justice.
2. Home is neat and clean.
3. Fireplace (located in the living room) is barricaded, making it inaccessible to children. Per Applicant, the fireplace will not be used. (photo taken)
4. Home is equipped with a fully charged fire extinguisher which is at least a 2A:10BC.
5. Home is equipped with multiple smoke detectors and a carbon monoxide detector, which were tested at the time of visit and observed to be operational.
6. Applicant stated that a cell phone with active service in the home will be the main contact number while children are in care.
7. All poisons, detergents, cleaning compounds, medications, etc. are inaccessible to children or are locked.
8. Hazardous materials are inaccessible and kept out of the reach of children.
9. According to the Applicant, there are no weapons or firearms in the home. None were observed by LPA.
10. Outdoor play area is free from defects or dangerous conditions.
11. Outdoor area is fenced/enclosed.
12. Home does not have a swimming pool. LPA observed no bodies of waters.
13. Toys and play items are safe, clean, and appropriate for the ages of the children.
14. Applicant agrees that baby-walkers, bouncers, jumpers, and similar items will not be used for children in care and are kept inaccessible.
15. The home is equipped with a first-aid kit equipped with, cleansing pads healing ointment, bandages, gauze, and a digital thermometer.
16. The home is equipped with a central air conditioning and heating system, which can be adjusted using a thermostat.
17. There is no garage.

The following was thoroughly discussed with the Applicant
·Applicant was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Joe Katrdzhyan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024
LIC809 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GRIGORYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700274
VISIT DATE: 05/14/2024
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order to disseminate information on the State’s licensing role, provide information to the public and parents
on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541.
Email Address: childcareadvocatesprogram@dss.ca.gov

·Commencing September 1, 2016, SB 792, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the inspection.

· Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Website: www.mandatedreporterca.com. Licensee was reminded of their responsibility to report suspected child abuse.

· Upon receipt by the licensee, licensees are to provide to parents/guardians the following: Copies of any licensing reports that document a Type A citation- this includes facility visits and substantiated complaint investigations; copy of licensing documents pertaining to a conference conducted by a local licensing agency management representative and the licensee of this family child care home in which issues of noncompliance are discussed or copies of a summary of an accusation indicating the Department's intent to revoke the


facility's license. Copies of any of the above licensing documents the licensee has received in the prior 12 months shall be provided to parents/guardians of newly enrolled child at the facility. (AB) 633

·Applicant was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family child care home during the hours of operation.

·The fire extinguisher type 2A-10BC must be services annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries should be replaced.



· A current roster of children enrolled must be maintained and available. 1596.841
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Joe Katrdzhyan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GRIGORYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700274
VISIT DATE: 05/14/2024
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·Applicant was reminded to report any unusual incidents or injuries to the Child Care Regional Office by telephone within 24 hours and in writing within 7 days.

·Applicant was reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome) and that the Provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome. Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials19-02 CCP Safe Sleep Awareness Campaign

· Applicant was reminded that only children eating may be in highchairs and that car seats are utilized only for transportation.



· Applicant was made aware that state law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category. 1596.846(b)(c)

· Applicant was reminded that it is the licensee’s, as well as anyone who assists in providing care, responsibility to know the regulations. Licensee was advised on how to access quarterly reports, forms, and regulations for Child Care online at www.ccld.ca.gov. Licensee was also encouraged to read the Child Care quarterly updates as they come out to stay informed of any changes or updates to statutes and regulations.



· In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR& Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.

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.

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Joe Katrdzhyan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024
LIC809 (FAS) - (06/04)
Page: 5 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GRIGORYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700274
VISIT DATE: 05/14/2024
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Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Because the Applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC 9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

On 1/30/24, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep, as an additional resource. LPA also informed [applicant, licensee, or facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. Reference Material from Title 22 Regulation Section 102425 / Infant Safe Sleep was also provided to the Applicant.
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Joe Katrdzhyan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GRIGORYAN FAMILY CHILD CARE
FACILITY NUMBER: 195700274
VISIT DATE: 05/14/2024
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LPA reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.
To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The following corrections are required by the Applicant, prior to licensure;

  • Applicant will submit a Declaration Form / LIC 855, stating that individual(s) who reside in the back home do not have access to the child care home and will have no contact with children in care. The Applicant declares under penalty of perjury that the statement provided is true and correct.
  • Applicant will submit a revised Facility Sketch (Yard), including the back home (ADU) located on the property.

An exit interview was conducted and report was reviewed with Applicant / Mariam Grigoryan..



A copy of this report was provided to the Applicant. Final license determination will be made upon review by the Licensing Program Manager and corrections of the above issues. Applicant to correct items by 5/17/24.
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Joe Katrdzhyan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024
LIC809 (FAS) - (06/04)
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