197494828-10-16-2025-58-CC-ALUZ-DMHT25-20251016142012

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494828
Report Date: 10/16/2025
Date Signed: 10/16/2025 02:20:27 PM

Document Has Been Signed on 10/16/2025 02:20 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 CARE		FACILITY NUMBER:	197494828
ADMINISTRATOR/ DIRECTOR:	KARINE GRIGORYAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 939-8268
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91605
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	10/16/2025
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:15 AM
MET WITH:	Karine Grigoryan		TIME VISIT/ INSPECTION COMPLETED:	02:30 PM

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	On 10/16/25 at 11:15AM, Licensing Program Analyst (LPA) Angela Luz and Licensing Program Manager (LPM) Emiko Bell arrived to the facility. Licensee Karine Grigoryan answered through the Ring doorbell that they would be home soon. Licensee arrived at 11:31PM, and assistant Lusine Grigoryan arrived shortly after. LPA explained the reason for visit is to conduct an unannounced Required - 3 Year inspection. The home was toured to conduct a Health and Safety Inspection. Licensee’s preferred language is Armenian. Lusine Grigoryan provided English/Armenian translation throughout the inspection. Days and hours of operation are from Monday to Friday 6AM to 12AM. Armenian is spoken to the children in care. This facility also goes by the name My Learning Corner. Physical Facility: Licensee toured the facility with LPA. The ON LIMIT AREAS are the living room, dining room, bedroom 2 and 3, bathroom, front yard, and side yard. The OFF LIMIT AREAS are bedroom 1, kitchen, and backyard. Bedroom 1 and backyard are rendered inaccessible by locked doors. The kitchen is rendered inaccessible by child gate. The home is neat and free of debris with heating and ventilation for safety and comfort. The ISOLATION AREA is bedroom 2. The outdoor play areas are the front yard and side yard. There is ample shade available in the side yard. LPA observed a swing set in the side yard. 8031 1/2 Van Noord Avenue shares the same main entrance as the facility. 8031 1/2 has their own residential entrance. There have been no changes from the areas previously identified as OFF LIMITS or alterations to existing building or grounds.

NAME OF LICENSING PROGRAM MANAGER: Betty Bell
NAME OF LICENSING PROGRAM ANALYST: Angela Luz
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: 197494828
	VISIT DATE: 10/16/2025

NARRATIVE

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LPA and LPM observed an in-ground pool in the back yard. The metal fence is in good repair and does not obscure the pool from view. One side of the fence is attached to the third residence on the property and the other side is attached to the exterior property wall. The fence is 5 feet high (60 inches), has a self-closing and self-latching gate, and does not have any potential hand or foot holds. Assembly Bill (AB) 2866 requires additional safety features that were missing during today's inspection:

A life ring with a minimum exterior diameter of 17 inches and labeled as approved by the United States Coast Guard.
A rescue pole with a body hook and minimum fixed length of 12 feet.
Daily inspection log of safety features and safety equipment before opening the facility.
Pool cover that meets American Society for Testing and Materials (ASTM) International Standard F2286 or pool alarm that meets ASTM International Standard F2208.

Photos were taken.

All hazardous materials and toxins are kept out of the reach of children. Licensee understands that any materials that are labeled “Keep out of reach of children” or have similar messaging should be kept out of reach from children in care. Licensee states that there are no firearms or other weapons in the home. The home has a fully charged 2A10BC fire extinguisher that was purchased on 4/21/25, working smoke detector, working carbon monoxide detector, and working telephone. LPA reminded that fire extinguishers should be serviced or newly purchased once a year.

Care and Supervision: There are ample age-appropriate toys that appear to be safe and in good condition. Licensee states they use redirection as a form of discipline. Licensee understands that children's personal rights should not be violated, including but not limited to, no corporal punishment, interference with eating, intimidation, or other actions of a punitive nature. Licensee understands that children are treated with dignity, receive safe, healthful, and comfortable accommodations. LPA reminded that Licensee is required to be present for 80% of operating hours per day. Licensee understands how to report Unusual Incidents/Injuries.

NAME OF LICENSING PROGRAM MANAGER: Betty Bell
NAME OF LICENSING PROGRAM ANALYST: Angela Luz
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025

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: 197494828
	VISIT DATE: 10/16/2025

NARRATIVE

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Record Review: Licensee Pediatric CPR/First Aid is current and expires 3/2027. Mandated Reporter Training for Child Care Providers is current and expires 1/13/27. Licensee was reminded that Mandated Reporter Training (AB1207) and CPR/First aid certifications needs to be renewed every two years. A copy of the licensee’s immunization is on file. The Licensee conducts and documents fire and disaster drills every six months, last drill was on 4/22/25. A current copy of the facility roster was viewed, and a copy was obtained. Licensee does not have liability insurance and Affidavit Regarding Liability Insurance (LIC 282) were found in children’s files. Entrance checklist for Family Child Care Home was provided and licensee was reminded of documents to be posted in a prominent, publicly accessible area of the facility. LPA reviewed 5 children files and 2 staff files during today's inspection. All files reviewed today were complete.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; 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.

NAME OF LICENSING PROGRAM MANAGER: Betty Bell
NAME OF LICENSING PROGRAM ANALYST: Angela Luz
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025

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: 197494828
	VISIT DATE: 10/16/2025

NARRATIVE

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During the exit interview, the LICENSEE, Karine Grigoryan, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. Megan's Law was checked on 10/15/25.

During today's inspection, 2 Type B deficiencies are issued on attached page 809-D.

Appeal rights were provided.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Karine Grigoryan.

NAME OF LICENSING PROGRAM MANAGER: Betty Bell
NAME OF LICENSING PROGRAM ANALYST: Angela Luz
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/16/2025 02:20 PM - It Cannot Be Edited

Created By: Angela Luz On 10/16/2025 at 01:37 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: GRIGORYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494828
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/16/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.814(a)(1)(B)(ii)(I)

Pool Safety

(ii) (I) An alarm that, when placed in a swimming pool, will sound upon detecting an entrance into the water. The alarm shall be turned on and be in working condition during a facility’s operating hours while the swimming pool is not in use. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, there was no pool alarm at the facility. The licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/14/2025
	Plan of Correction
1 2 3 4	By plan of correction due date, Licensee will submit proof to the Department of a pool alarm that meets American Society for Testing and Materials (ASTM) International Standard F2208.

Type B

Section Cited

HSC

1596.814(a)(2)

Pool Safety

(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements: (2) The licensee shall have the following safety equipment visible from the swimming pool and readily available for immediate use: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not have a life ring with a minimum exterior diameter of 17 inches and labeled as approved by the United States Coast Guard, a rescue pole with a body hook and minimum fixed length of 12 feet, or daily inspection log of the drowning prevention safety features. The licensee did not comply with the section cited above in 3 of 3 requirements which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/14/2025
	Plan of Correction
1 2 3 4	By plan of corrections due date, Licensee will submit proof to the Department that the facility has a life ring with a minimum exterior diameter of 17 inches and labeled as approved by the United States Coast Guard, a rescue pole with a body hook and minimum fixed length of 12 feet, and a daily inspection log of the drowning prevention safety features and safety equipment.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Betty Bell
NAME OF LICENSING PROGRAM MANAGER:

	Angela Luz
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025

LIC809 (FAS) - (06/04)

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