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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197409052
Report Date: 08/05/2024
Date Signed: 08/23/2024 09:28:19 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/08/2024 and conducted by Evaluator Elicia Calvillo
COMPLAINT CONTROL NUMBER: 58-CC-20240508160246
FACILITY NAME:GROZOV FAMILY CHILD CAREFACILITY NUMBER:
197409052
ADMINISTRATOR:GROZOV, EDITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 727-1255
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY:14CENSUS: 2DATE:
08/05/2024
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Edita Grozov, LicenseeTIME COMPLETED:
04:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee left children at the home alone unsupervised
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
THIS IS AN AMENDED REPORT WHICH SUPERSEDES THE ORIGINAL REPORT DATED 08/05/2024.

On 08/05/2024 at 01: 15 PM, Licensing Program Analyst (LPA) Elicia Calvillo conducted a complaint visit to deliver findings on the above allegation. LPA 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 2 children present.

Throughout the course of the investigation, LPA obtained the LIC 9040 Child Care Facility Roster, obtained photos, interviewed Licensee, interviewed parents, and interviewed children. During today’s visit, LPA addressed the allegation that Licensee left children at the home alone unsupervised.

Page 1 of 2
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 58-CC-20240508160246
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 08/05/2024
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
Information provided by the Reporting Party (RP) indicates that on 05/08/2024 they arrived at the facility at 02:00PM to pick up Child #2. RP telephoned the Licensee twice but was unable to contact the Licensee. At approximately 02:37 PM, RP sent a text message to the Licensee that RP was at the Licensee’s home to pick up Child #2. Shortly after Licensee pulled up into the driveway in their car. Per RP, when Licensee opened the front door to the facility, they observed that Child #1 and Child #2 were left in the home alone. Licensee stated to RP that the children nap from 1:30PM-3:00PM and during this time the Licensee goes to pick up the other children at school.

Licensee on 05/16/2024, disclosed they singularly take care of children at the facility and do not employ an assistant due to low enrollment. Adult #1 lives in home but does not help with day care. Licensee admitted they will pick up children at school in the event of an emergency. On 08/05/2024, Licensee disclosed Adult #2 visits to perform facility maintenance and Adult #3 is part time assistant effective 05/22/2024.

When interviewing parents, Parent #2 (P2) disclosed that the Licensee picks up Child #4 (C4) every day from school, Monday, Wednesday, Thursday, and Friday at 2:24PM and Tuesday at 1:34PM. Parent #2 also disclosed that Adult #2 has been present at the facility.

When interviewing children, Child #1 (C1) disclosed they have woken up from a nap and Licensee was not there (at facility).

Based on LPA’s observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegations is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 Chapter 3, Section number 102417 (a) Operation of a Family Child Care Home), is being cited on the attached deficiencies page.

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: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 58-CC-20240508160246
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/06/2024
Section Cited
CCR
102417(a)
1
2
3
4
5
6
7
102417 Operation of a Family Child Care Home (a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times. This requirement is not met as evidenced by:
Observation, record review, and interviews conducted in that
1
2
3
4
5
6
7
Licensee stated they will notify parents that Licensee will no longer pick up children from school. Licensee will provide LPA a copy of the parent notification by plan of correction due date 08/06/2024.
8
9
10
11
12
13
14
Licensee did not have an assistant and P2 disclosed that the Licensee picks up children daily from school and C1 disclosed no one present when they wake from nap time, which poses an immediate health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3