<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
195700303
Report Date:
05/23/2024
Date Signed:
06/13/2024 03:26:34 PM
Document Has Been Signed on
06/13/2024 03:26 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:
GARKAVENKO FAMILY CHILD CARE
FACILITY NUMBER:
195700303
ADMINISTRATOR/
DIRECTOR:
ANNA GARKAVENKO
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(818) 946-4983
CITY:
WEST HILLS
STATE:
CA
ZIP CODE:
91306
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
14
CENSUS:
DATE:
05/23/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
10:59 AM
MET WITH:
Ana Garkavenko
TIME VISIT/
INSPECTION COMPLETED:
11:00 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
SUPERVISORS NAME
:
Raul Navarro
LICENSING EVALUATOR NAME
:
Tatiana Bickham
LICENSING EVALUATOR SIGNATURE
:
DATE:
05/23/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
1