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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021709
Report Date: 04/21/2026
Date Signed: 04/21/2026 02:26:59 PM

Document Has Been Signed on 04/21/2026 02:26 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:GRIGORYAN FAMILY CHILD CAREFACILITY NUMBER:
198021709
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 0DATE:
04/21/2026
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Hayarpi Grigoryan, LicenseeTIME VISIT/
INSPECTION COMPLETED:
02:40 PM
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CASE- MANAGEMENT INSPECTION CONDUCTED IN ARMENIAN
On 04/21/26, at 12:30 PM Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced case- management inspection to the above facility due to licensee is requesting capacity increase. LPA met with licensee, Hayarpi Grigoryan who guided analyst on a tour of the facility. During this inspection licensee's daughters, Susanna Poghosyan and Anna Poghosyan were also present in the home. Per licensee, facility operation hours are Monday to Friday, 7:00 a.m. to 9:00 p.m.., Licensee states she cares for children 0-13 years old. Per licensee, currently she has 7 after-school children enrolled in her daycare who are attending the daycare after 1:30 PM. During this inspection no children were present in the home.

Fire clearance for Large Family Child Care Home was granted on 04/20/26.

This is a one story home located on the first level. The home consists of 4 bedrooms, 2 restrooms, living room, dining room, kitchen, detached garage, detached storage, front yard (fenced) and backyard (fenced). Per licensee, parents enter the home through the main entrance which leads to the front yard and home main entrance which leads to the living room.

Per licensee the children use the bathroom in the bedroom, living room, dining room, two bedrooms, and front yard (fenced). Per licensee areas off limits to children and parents include: Two bedrooms, kitchen, one-bathroom, back yard, detached garage and storage. LPA did not observe any stairs in the home during this inspection.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. At 12:55 p.m., the licensee began touring LPA’s through the home starting with the entry way which led directly to the living room and dining room. There is a screen door with (2) locks on the


REPORT CONTINUES ON NEXT PAGE 1 of 4
NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2026
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 5
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GRIGORYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021709
VISIT DATE: 04/21/2026
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front entrance. In addition, the wrought iron railings and openings leading to front door are covered with mesh. The living room and dining room were inspected, and electrical outlets were observed to be covered. LPA observed children’s tables, chairs, toys and a piano in the living room. LPA observed a child safety gate was installed to the living room to separate the living room from dining room. Next LPA toured the dining room and LPA observed a wall/floor heather in the dining room which has been blocked off by a screen to prevent access. LPA observed a sofa, a coffee table, a dining table, chairs, children tables, and chairs in the dining room. Next to the living room, the daycare bedroom was inspected, and LPA observed 8 children napping cots in the bedroom. Next LPA toured the daycare bathroom which is located between two bedrooms and did not observe any hazards. Next LPA toured the second daycare bedroom and observed two beds in the bedroom. Daycare two bedrooms and daycare bathroom are connected to each other by doors. Next LPA toured the two off-limit bedrooms and one off-limit bathroom in the hallway and did not observe any hazards. Next LPA toured the off-limit kitchen and observed child proof safety latches on the cabinets where licensee stores sharp items and cleaning compounds. There is a door in the kitchen which leads to the laundry room and backyard. LPA observed licensee's personal belongings in the home. LPA observed the required 2A 10BC fire extinguisher was anchored to the wall in the laundry room. It was serviced on 03/05/26 as read by LPA from the service tag. Licensee tested the carbon monoxide and smoke detectors in the living room. It sounded off the alarms and heard by LPA to be functional. Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children.

Next LPA toured the front yard fenced. Per licensee, children use the front yard for outdoor play time. The outdoor play area was observed to be fenced. 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 a danger to children on the outdoor yard. LPA observed 3 locks on the main entrance gate. The front yard ground is outdoor carpet. The licensee states that supervision is always provided. Next LPA toured the backyard (fenced) and off-limit detached garage and storage and did not observe any hazards. There is a gate in the backyard which leads to the alley.

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. Per Licensee, at 1:45 p.m there are no pets, weapons, firearms, pools, spas, hot tubs, fish ponds, or similar bodies of water on the premises.


REPORT CONTINUES ON NEXT PAGE 2 OF 4
NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GRIGORYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021709
VISIT DATE: 04/21/2026
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The licensee was observed to be operating within the licensed capacity and is not exceeding the required limitations during this inspection. During this inspection no children were present in the home. All adults present have obtained a criminal record clearance on Licensing Information System (LIS). Per licensee, currently she does not have assistant and if it is needed her adult daughters assist her. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 02/2027. Licensee, Hayarpi Grigoryan completed required mandated reporter training on 02/19/25. There are first aid supplies available on the premises in the laundry room in a closet. LPA advised licensee that if a child shows signs of illness he/she/they shall be separated from other children.

At 1:10 p.m., facility roster was reviewed and completed. Per licensee currently there are 7 after-school children enrolled.

The licensee has proof of immunization against influenza, pertussis, and measles. 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 01/29/26.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted at the wall by the entrance in the living room. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home. There is telephone service via a cellphone that is used and the cellphone stays at the facility during operation hours. Per licensee she carries liability insurance in accordance with standard established by Family Child Care statue.

Licensee RENTS/LEASES THE HOME: The licensee provided proof of control of property. Licensee rents the home and has landlord consent form on file. Licensee confirmed that LIC 9149 was signed by landlord.


REPORT CONTINUES ON NEXT PAGE 3 of 4
NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GRIGORYAN FAMILY CHILD CARE
FACILITY NUMBER: 198021709
VISIT DATE: 04/21/2026
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INFANT CARE: Licensee states that currently she does not have an infant enrolled in her daycare. Licensee states that if an infant is enrolled, the infant will sleep in the two daycare bedrooms where they are constantly supervised. LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date.

Medication: Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 2202-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) 5140383 (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/. LPA advised the licensee to access forms, regulations and quarterly updates online at: www.ccld.ca.gov.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today from the areas that were inspected today.

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

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


REPORT END 4 of 4
NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026
LIC809 (FAS) - (06/04)
Page: 5 of 5