<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700669
Report Date: 10/20/2023
Date Signed: 10/20/2023 02:07:24 PM

Document Has Been Signed on 10/20/2023 02:07 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:GRIGORYAN FAMILY CHILD CAREFACILITY NUMBER:
197700669
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
10/20/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:36 AM
MET WITH:Knarik GrigoryanTIME COMPLETED:
10:59 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 10/20/2023 LPA Isabel Ortega conducted a pre-licensing/Case Management inspection as Licensee is requesting a relocation and to increase capacity from 8 children to 14 children. LPA announced the purpose of the inspection and was granted entry by Licensee. A tour of the facility was completed. Upon arrival LPA observe one child in care and two staff providing supervision.

Licensee was initially licensed on 1/29/2021 as a Small Family Child Care Home, then relocated on 1/19/2023. The Fire Department has inspected the home and granted a fire clearance for 14 children on 9/28/2023. Family Child Care Home operates Monday through Friday from 7:00 a.m. to 10:00 p.m. The facility provides breakfast, morning snacks, lunch, afternoon snacks and dinner as needed.

This is a two-story family home which consist of five bedrooms, two bathrooms, a kitchen, dining room, living room, attached garage and back yard. Room #1 and room #2 on the first level of the home will be the primary location in which care is provided referred to as the Child Care Play area. Children will utilize the bathroom located to the left from the main entrance towards the hallway. The off-limit areas include the entire second floor which consist of two restrooms, room #3, #4, and #5(on second floor child safety gate observed) and attached garage (key locked observed).

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2023
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GRIGORYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700669
VISIT DATE: 10/20/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The backyard is utilized by the children for outside play and is fenced all around. The outdoor play area was inspected and play equipment was observed to be free of hazards, loose and sharp parts. LPA observed age-appropriate toys both inside and outside of the home.

The facility’s fire extinguisher (2A10BC) is reading in green and met the State Fire Marshal standards. Licensee tested the smoke and carbon monoxide detectors at 11:00 a.m., and LPA found them to be in operable condition. The facility annual fees are current. The parent board was reviewed and had all the required forms posted and visible to parents.

Licensee is reminded with a capacity increase she must have a qualified assistant present whenever more than 8 children in care. Licensee was provided with a capacity and ratio handout pertaining to large Family Child Care Homes and the various age groups that can be under care at one given time.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 http://www.ada.gov/childqanda.htm

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GRIGORYAN FAMILY CHILD CARE
FACILITY NUMBER: 197700669
VISIT DATE: 10/20/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Licensee was reminded with a capacity increase she must have a qualified assistant present whenever she has more than 8 children in care. Licensee was provided with a capacity and ratio handout pertaining to large Family Child Care Homes and the various age groups that can be under care at one given time.

Licensee has met Title 22 regulations; Fire clearance was granted 9/28/2023, therefore, a Large Family Child Care Home License capacity of 14 children will be granted effective 10/20/2023.



An exit interview was conducted, and a copy of this report, appeal and notice of site visit was provided to Licensee on this day. All Licensing reports are recommended to be kept on file for a minimum of three years. Notice of site visit (NOA) shall be posted for 30 days from today.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3