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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700274
Report Date: 06/06/2024
Date Signed: 06/06/2024 01:16:15 PM

Document Has Been Signed on 06/06/2024 01:16 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:
06/06/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Applicant / Mariam Grigoryan
Landlord / Gor Mnatsakanyan		TIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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 THIS MEETING WAS CONDUCTED IN ENGLISH AND ARMENIAN
An in-person informal office meeting was held on 6/6/24, at 10AM at the El Segundo North Child Care Regional Office. Present during this informal meeting were, Licensing Program Manager (LPM) / Rita Ramos, Licensing Program Analyst (LPA) / Joe Katrdzhyan, Licensing Program Analyst (LPA) / Suzette Ornelas, Interim Regional Manager / Adriana Hernandez, Applicant/Licensee: Mariam Grigoryan and Landlord / Gor Mnatsakanyan. The purpose of this informal office meeting was to issue a provisional license for the change of location from facility #197493505 to facility #195700274. Applicant / Mariam Grigoryan has agreed and will provide the following documents to LPA Katrdzhyan no later than July 5, 2024.
  • Certificate of completion on training for the Personal Rights of children.
  • Declaration from Applicant stating that she understands the personal rights of children and will not violate them.
  • Declaration for not being forthcoming about the property/ADU located in the back of the property.
  • Declaration stating that the children in her care will not commingle with the children at the licensed facility (ADU) located behind the property, #195700216.
  • Declaration from Applicant stating that Applicant has reviewed and understands Title 22, Regulations Section 102417(a) / Operation of a Family Child Care Home that the Licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.
  • Declaration from Applicant stating that she has reviewed and understands Government Code Section 224, which states:
      • In determining the place of residence the following rules shall be observed:
      (a) It is the place where one remains when not called elsewhere for labor or other special or temporary purpose, and to which he or she returns in seasons of repose.
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Joe Katrdzhyan
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2024
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: 06/06/2024
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(b) There can only be one residence.

(c) A residence cannot be lost until another is gained.

(d) The residence of the parent with whom an unmarried minor child maintains his or her place of abode is the residence of such unmarried minor child.

(e) The residence of an unmarried minor who has a parent living cannot be changed by his or her own act.

(f) The residence can be changed only by the union of act and intent.

(g) A married person shall have the right to retain his or her legal residence in the State of California notwithstanding the legal residence or domicile of his or her spouse.


An exit interview was conducted with Applicant / Mariam Grigoryan and a copy of this report was provided.
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Joe Katrdzhyan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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