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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197409052
Report Date: 08/23/2024
Date Signed: 08/23/2024 09:35:14 AM

Document Has Been Signed on 08/23/2024 09:35 AM - 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:GROZOV FAMILY CHILD CAREFACILITY NUMBER:
197409052
ADMINISTRATOR/
DIRECTOR:		GROZOV, EDITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 727-1255
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY: 14TOTAL ENROLLED CHILDREN: 2CENSUS: 0DATE:
08/23/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:01 AM
MET WITH:Edita Grozov, LicenseeTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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On 08/23/2024 at 08:01 AM, Licensing Program Analysts (LPAs) Elicia Calvillo and Roberto Luque Avila conducted a Case Management -Deficiencies visit. LPAs identified self and met with Edita Grozov, Licensee, who allowed entry into the facility and provided LPA a guided tour of the inside and outside of the facility. Upon arrival there were 0 children present.

During today’s visit, LPAs are addressing that an individual Viktor Grozov has been present at the facility and does not have a Criminal Background Clearance or exemption. On 08/05/2025, Licensee disclosed that Viktor Grozov is in the facility during the hours of operation to perform maintenance. On 07/30/2025, Parent #2 disclosed that Viktor Grozov is present at the facility when they pick up their children. And on 05/08/2024, Parent #1 disclosed that Viktor Grozov is present at the facility when they pick up their children.

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.

Based on the information provided by Licensee, Parent #1, and Parent #2, the following deficiency listed on the attached deficiency page is being cited in accordance with California Code of Regulations Title 22. A Type A, deficiency was issued for regulation 102370 (d)(1) Criminal Record Clearance and a Plan of Correction is due 08/26/2024. A Civil Penalty of $300.00 will be assessed today due to Viktor Grozov not having a Criminal Record Clearance associated to the facility.
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2024
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GROZOV FAMILY CHILD CARE
FACILITY NUMBER: 197409052
VISIT DATE: 08/23/2024
NARRATIVE
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A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. During this visit, the Licensee was provided with a copy of LIC 9224 Acknowledgement of Receipt of Licensing Reports Form and LIC 995A Notification of Parents’ Rights.

The Notice of Site Visit (LIC 9213) must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Edita Grozov, Licensee, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/23/2024 09:35 AM - It Cannot Be Edited


Created By: Elicia Calvillo On 08/23/2024 at 09:09 AM
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: GROZOV FAMILY CHILD CARE
FACILITY NUMBER: 197409052

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/26/2024
Section Cited
CCR
102370(d)(1)

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Criminal Record Clearance (d) All individuals subject to a criminal record...shall prior to working, residing, or volunteering in a licensed facility:(1) Obtain a California clearance or a criminal record exemption...
This is not met as evidenced by:
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Licensee stated that they will have Viktor Grozov obtain a Criminal Record Clearance by the plan of correction due date 08/26/2024.
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Observation, record review, and interviews conducted in that Licensee disclosed Viktor Grozov is present in the facility, P1 and P2 disclosed that Viktor Grozov is present at the facility when they pick up their children, which poses an immediate health, safety, or personal rights risk to person 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.
SUPERVISOR'S NAME:Rita Ramos
LICENSING EVALUATOR NAME:Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2024


LIC809 (FAS) - (06/04)
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