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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021167
Report Date: 02/07/2025
Date Signed: 02/07/2025 01:58:31 PM

Document Has Been Signed on 02/07/2025 01:58 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:GRIGORYAN FAMILY CHILD CAREFACILITY NUMBER:
198021167
ADMINISTRATOR/
DIRECTOR:		KNARIK GRIGORYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 213-0463
CITY:GLENDALESTATE: CAZIP CODE:
91203
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
02/07/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:20 AM
MET WITH:Knarik Grigoryan TIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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 Annual Inspection was conducted in Armenian.
On 02/07/2025 , at 11:30 am Licensing Program Analyst (LPA) Shushanik Safaryan conducted an annual random inspection to the above facility. LPA met with Licensee, Knarik Grigoryan , to whom the reason for the visit was explained. Per Licensee, there are 17 children currently enrolled. LPA observed 10 children present with 2 assistants upon arrival. The licensee was observed to be operating within the license capacity limitations.
During this inspection individuals who reside in the home were discussed and notes on Confidential Name List (LIC811) and attached to this report.

All areas identified on the facility sketch were inspected. This is a one-story home located on the first level. The home consists of 2 bedrooms, 1 restroom, living room, dining room, kitchen, detached garage, detached playroom in the backyard, front yard, and backyard (fenced). There is a fireplace in the living room which has been blocked off to prevent access to children.
Per applicant, parents enter the home through the side gate which leads to the backyard and to the dining room.
During this visit, all areas identified that are accessible for children to use were inspected for the safety, comfort, and cleanliness. At 11:45 am , Licensee guided LPA to the tour of the home. LPA was toured starting from the side gate that leads to the yard and to the dinning room . In the dining room LPA observed children tables and chairs , place for children belongings. Next LPA toured the living room and did not observe any hazards. Per licensee children don’t use the living room. Next LPA toured bedroom #1 and observed colorful carpet , toys. Per licensee bedroom used as a napping area for younger children. LPA observed napping cots stored in the closet in the bedroom. Next LPA toured the bathroom next to the bedroom and did not observe any hazards . Per licensee children are always under supervision . Next LPA toured licensee`s bedroom and observed bed and personal belongings and did not observe any hazards .All required postings were observed on the wall in the dining room. LPA observed door to the kitchen closed .
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GRIGORYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021167
VISIT DATE: 02/07/2025
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Per licensee children don’t go to the kitchen and door is always closed. LPA toured the kitchen and observed another door leading to the yard . Per licensee door is locked children go to the yard through the dining room door . Toured continued to the detached garage, which was used as a storage area , door observed to be closed. Next LPA toured the bathroom located outside and did not observe any hazards. Per licensee bathroom used when children play outside or in a play area. Next LPA toured the playroom next to the detached garage. In the playroom LPA observed 10 children with 2 assistants . Per licensee this room used when children conduct activities that need more cutting, painting and creates more mess. Per licensee she understands it is only for limited hours and children can not sleep or eat inside . LPA observed toys , tables, chairs. In the outdoor area and in the kitchen , LPA observed required 2A 10BC fire extinguisher serviced with the service date read from the tag by LPA 04/31/2024. Smoke and carbon monoxide detectors in the kitchen were tested and are operable.

There is telephone service via a cellphone that stays at the facility during operation hours. Hours of operation are Monday – Friday, 08:00 am – 6:00 pm. Per licensee she provides part time care on the weekend too. There is central air and heating in the home.

Detergents, cleaning compounds, and medications were observed to be inaccessible to children. Per Licensee, there are no poisons in the home. LPA advised that any poisons should be locked under key or combination lock. Licensee states that there are no firearms or weapons stored in the home. At 11:30 am , Licensee stated no bodies of water in the premises, and none were observed .

All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. Last drill documented was conducted on 02/07/2025.

The home is observed to be clean and orderly. There are first aid supplies available in the bathroom cabinet . There are age-appropriate toys available for children.

Per licensee, she provides food for children in care. Licensee was advised that if food is brought from the children’s homes, all containers must be labeled with child’s name and properly stored or refrigerated.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GRIGORYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021167
VISIT DATE: 02/07/2025
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Currently, children are using the backyard for outdoor play time. The outdoor play area was observed to be fenced and gated. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that can pose danger to children.

At 12:00 pm Licensee`s and staff records were reviewed. The licensee has completed training on preventive health practices including Pediatric First Aid and CPR. LPA observed that at least one person who has a current certificate in pediatric first aid and pediatric cardiopulmonary resuscitation available at all times.

LPA observed that the Licensee does have proof of Mandated Reporter AB 1207 compliant Child Care Training Certificate on file with expiration on 03/11/2026 www.mandatedreporterca.com

At 12:20 pm , LPA observed two assistants are missing proof of immunization .(MMR, Pertussis). Per licensee she was not aware of need of immunization for the assistants . Licensee stated she will obtain necessary immunization and will notify LPA .

Children’s records were reviewed, including emergency information, and were observed to be complete. Per licensee she cares only for 2 infants over 12 months .

LPA created an LIC 857, Children’s Record Review, and LIC 859, Staff Record Review which documents staff and children’s files reviewed during this inspection.

Per licensee, there are no animals in the facility. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.
LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, and/or any other item that fall into these categories are not permitted in a family childcare facility.

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/.
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GRIGORYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021167
VISIT DATE: 02/07/2025
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To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/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.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing website at www.ccld.ca.gov.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California

During the exit interview, the LICENSEE Knarik Grigoryan , confirmed that there are no Registered Sex Offenders living in the facility.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GRIGORYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021167
VISIT DATE: 02/07/2025
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Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

LPA discussed all the deficiencies cited during today’s inspection with the licensee. Per licensee, she understands all the deficiencies and plan of correction .

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


Failure to comply with posting requirements shall result in an immediate civil penalty of $100.



Exit interview conducted and report was reviewed with the licensee Knarik Grigoryan on 02/07/2025.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/07/2025 01:58 PM - It Cannot Be Edited


Created By: Shushanik Safaryan On 02/07/2025 at 01:08 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GRIGORYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021167

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations and records review , interview the licensee did not comply with the section cited above . During the file review LPA observed assistants are missing proof of immunizations (MMR, Pertusis), which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/28/2025
Plan of Correction
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Licensee stated she will obtain immunizations records and will email to LPA by POC date
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Brandi VanOosten
LICENSING EVALUATOR NAME:Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2025


LIC809 (FAS) - (06/04)
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