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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700186
Report Date: 09/16/2025
Date Signed: 09/16/2025 02:51:19 PM

Document Has Been Signed on 09/16/2025 02:51 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:GEVORGYAN FAMILY CHILD CAREFACILITY NUMBER:
197700186
ADMINISTRATOR/
DIRECTOR:		GEVORGYAN, KARINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(747) 777-0306
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
09/16/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Karine Gevorgyan, LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
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On 09/16/2024, Licensing Program Analysts (LPA) Elicia Calvillo conducted an unannounced 3 Year Required Annual inspection at Gevorgyan Family Child Care, #197700186, located at 16511 Chatsworth Street, Granada Hills, CA 91344.

LPA arrived at the facility at 11:30 AM and walked up to the front door and pressed the door bell, LPA observed there is a camera on the door bell and another camera hanging from the roof (photo taken), the door has a glass panel (photo taken) and LPA could see inside the facility, there was movement. LPA rang the door bell again, LPA observed 8 children who were standing next to a cabinet (photo taken) and who appeared taller than the cabinet and 1 male adult, there was more movement inside the facility. LPA rang the door bell again, LPA observed more movement then 2 women appeared and LPA observed smaller children coming from the back door (play yard). At 11:41 AM, LPA called the facility phone number and spoke to Karine Gevorgyan, LPA identified self and told Licensee they were at the front door to conduct an Annual Inspection. Licensee hung up and at 11:45 AM, LPA was allowed entry into the facility. A Type A Citation will be issued for section 102370 (a) Criminal Record Clearance with a Plan of Correction due 09/17/2025, and a Civil Penalty of $500.00 is accessed for the unknown adult male.

Upon entry into the facility there were two (2) assistants and 9 children present. LPA observed that the children were not the same height as the children that LPA observed through the glass door panel. LPA asked the children did they come from the other building (an Accessory Dwelling Unit), Facility # 197494747 Gabrielyan Family Child Care located at 16513 Chatsworth Street, Granada Hills, CA 91344. LPA asked the children if they came from the other house, the children nodded yes and said "yes". LPA asked the children to show LPA where they came from and a group of children went outside to show LPA where they came from
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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Elicia Calvillo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2025
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: GEVORGYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700186
VISIT DATE: 09/16/2025
NARRATIVE
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and Staff #1 was behind LPA on the phone with Licensee, then Child #1, Child #2, Child #3, Child #4, and Child #5 took LPA and pointed to the gate that separates the two (2) facilities. As LPA and the children approached the gate, Staff #1 yelled at the children in Armenian language and they stopped and went back with the assistant. Staff #1 refused to open the gate that leads to the ADU.

LPA tired to communicate with the Staff #1 and Staff #2, both said they did not speak English, LPA stated they would call for an interpreter. The Licensee was on the speaker phone and told LPA they were at a Doctor's Appointment and they were on their way back to the facility. Staff #2 seemed to understand English as Staff #2 was giving a tour of the facility LPA was asking questions. Staff #2 guided LPA on a tour of the inside of the facility (photos taken) of all the rooms at the facility.

Licensee arrived at the facility and LPA asked why the children were in the ADU. Licensee denied that the children were at the other facility. LPA asked for the Licensee to open the gate and Licensee refused stating it was dangerous. LPA stated that the children told LPA they came from the other side of the gate and showed LPA the gate. A Type A citation will be issued today for section 102391(a) Inspection Authority of the Department with a plan of correction due 09/17/2025 and a Civil Penalty of $500.00 because LPA was not allowed entry through the gate.

LPA used the Children's Roster to conduct a name to face count of the children. The children told LPA their names expect for two (2) children, Licensee said their names and LPA repeated the names and both nodded) and one (1) child was not listed on the roster.

As a result of today's visit, the following deficiencies listed on the attached deficiency page are being cited in accordance with California Code of Regulations Title 22. Two (2) Type A Deficiencies was issued for regulation 102391(a) Inspection Authority of the Department with a plan of correction due 09/17/2025 and 102370 Criminal (a) Record Clearance with a Plan of Correction due 09/17/2025, and a Civil Penalty assessed for $1,000.00

LPA Calvillo informed Licensee Karine Gevorgyan that this report dated 09/16/2025 document(s) two (2) Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.
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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Elicia Calvillo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
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: GEVORGYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700186
VISIT DATE: 09/16/2025
NARRATIVE
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Also, LPA Calvillo informed the Licensee to provide a copy of this licensing report dated 09/16/2025 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other
written statement, must be placed in the child's file for verification.

Due to time constraints, LPA will return at a later date to complete the Required Annual Inspection.

A Notice of Site Visit was given and must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to comply with posting requirement will result in an immediate civil penalty of $100.00.

Exit interview was conducted with Karine Gevorgyan, Licensee including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Elicia Calvillo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/16/2025 02:51 PM - It Cannot Be Edited


Created By: Elicia Calvillo On 09/16/2025 at 01:40 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: GEVORGYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700186

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/17/2025
Section Cited
CCR
102391(a)

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102391 Inspection Authority of the Department (a) (a) Any duly authorized ...Department shall, upon presentation of proper identification, enter and inspect any place providing personal care, supervision, and services at any time, ...
This requirement is not met as evidenced by:
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Per Licensee, they wil review the CDSS.CA.GOV website and review the Departments Inspection Authority regulations and videos and provide LPA with a summary of the information obtained by the Plan of Correction due date 09/17/2025.
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that Licensee would not open the gate where children said they were at which poses an immediate health, safety or personal rights risk to persons in care.
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Type A
09/17/2025
Section Cited
CCR102370(a)

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102370 Criminal Record Clearance (a) Prior to the Department issuing a license, the applicant(s) and all adults residing in the home shall obtain a California criminal record clearance or exemption. This requirement is not met as evidence by:
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Per Licensee, they will review the CDSS.CA.GOV website and review the Departments Criminal Record regulations and videos and provide LPA with a summary of the information obtained by the Plan of Correction due date 09/17/2025.
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that Licensee would not disclose who the Adult Male was at the facilitybwhich poses an immediate health, safety or personal rights risk to persons in care.
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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.
Rita Ramos
NAME OF LICENSING PROGRAM MANAGER:
Elicia Calvillo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/16/2025


LIC809 (FAS) - (06/04)
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