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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700498
Report Date: 11/15/2021
Date Signed: 11/15/2021 10:00:19 AM

Document Has Been Signed on 11/15/2021 10:00 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:GRIGORYAN FAMILY CHILD CAREFACILITY NUMBER:
197700498
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
11/15/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:09 AM
MET WITH:Susanna GrigoryanTIME COMPLETED:
10:10 AM
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Licensing Program Analysts (LPAs) Liana Stepanyan and Lady King-Lewis conducted a case management inspection with Licensee Susanna Grigoryan, who guided analysts on a tour of the home. Licensee provided facility sketch showing the main day care area will take place in the living room, attached rear structure/play room, with bathroom #3 and out door play area will take place in rear side yard.

Licensee hours of operations will remain the same Monday through Friday 7:30 to 6:00pm serving children ages 0-13.



The off limits area of the day care will be all bedrooms in the home, bathroom # 1, # 2, kitchen, east side yard, rear side yards and storage structure behind car port are off limits.

Family members residing in the home remains the same as the pre-licensing report.

An exit interview was conducted a copy of the report was reviewed with licensee. A notice of site visit, appeal rights, and copy of this report was provided to licensee.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Liana Stepanyan
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2021
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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