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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495152
Report Date: 10/10/2023
Date Signed: 10/10/2023 01:46:49 PM

Document Has Been Signed on 10/10/2023 01:46 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:GARKAVENKO FAMILY CHILD CAREFACILITY NUMBER:
197495152
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 6DATE:
10/10/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:47 PM
MET WITH:ANNA GARKAVENKO - LicenseeTIME COMPLETED:
01:46 PM
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On 10/10/2023 Licensing Program Analyst (LPA), Suzette Ornelas, conducted an announced capacity increase and an unannounced Annual Required Inspection. LPA was met by Licensee, Anna Garkavenko and LPA explained that during the earlier annual inspection/capacity increase inspection, there was a glitch and the children's record review LIC857 did not save. Therefore, LPA had to return to obtain the information regarding the children's records.

LPA obtained children's record review information during this visit. Exit interview conducted with licensee Anna Garkavenko.

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2023
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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