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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700303
Report Date: 06/11/2024
Date Signed: 06/11/2024 10:11:28 AM

Document Has Been Signed on 06/11/2024 10:11 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:GARKAVENKO FAMILY CHILD CAREFACILITY NUMBER:
195700303
ADMINISTRATOR/
DIRECTOR:
ANNA GARKAVENKOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 946-4983
CITY:WEST HILLSSTATE: CAZIP CODE:
91306
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
06/11/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:24 AM
MET WITH:Anna GarkavenkoTIME VISIT/
INSPECTION COMPLETED:
10:20 AM
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Licensing Program Analyst (LPA) Tatiana Bickham conducted an announced pre-licensing inspection for a large family child care at the above facility on 06/11/2024 at 9:24 AM. LPA met with Applicant Anna Garkavenko and spouse, who guided analyst on a tour of the facility. There were no children present when LPA arrived.

The purpose if this visit is to follow up with the applicant and ensure she lives in the home. This is single story home that was originally a garage converted into a single dwelling unit. The unit sits on the same property of the home where the applicant is currently licensed, the main home has a different address. There is a gate in between the main house and the single dwelling unit separating the two properties. This home has an open floor plan consisting of a kitchen, living area, bathroom, and front yard.

LPA informed the applicant in order to be licensed for a family child care home one must reside at the address in which they want to provide care, applicant states she understands. LPA also informed the applicant if for any reason Licensing confirms the applicant is not living in the home the license can be revoked. Applicant made a Declaration statement on Licensing Form 855 stating she does live in the home at the above address. LPA observed clothes, shoes and a roll away bed in the closest, toiletries in the bathroom and person items throughout the home.

A notice of site visit was given to Applicant and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted and report was reviewed with the Applicant.  Once licensed, the applicant is required to adhere to the terms and limitation as stated on the license.

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
SUPERVISORS NAME: Raul Navarro
LICENSING EVALUATOR NAME: Tatiana Bickham
LICENSING EVALUATOR SIGNATURE: DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/11/2024
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: GARKAVENKO FAMILY CHILD CARE
FACILITY NUMBER: 195700303
VISIT DATE: 06/11/2024
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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.
SUPERVISORS NAME: Raul Navarro
LICENSING EVALUATOR NAME: Tatiana Bickham
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
LIC809 (FAS) - (06/04)
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