Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 192007738
Report Date: 05/08/2018
Date Signed 05/09/2018 08:24:50 AM


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/14/2018 and conducted by Evaluator Silva Garibyan
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20180214145655
FACILITY NAME:SAN GERMAN FAMILY CHILD CAREFACILITY NUMBER:
192007738
ADMINISTRATOR:SAN GERMAN, MARIA GERARDOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 767-0313
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY:14CENSUS: 5DATE:
05/08/2018
UNANNOUNCEDTIME BEGAN:
07:25 AM
MET WITH:Maria San GermanTIME COMPLETED:
08:55 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights: Staff hit child.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA), Silva Garibyan conducted an unannounced complaint visit for the purpose of concluding the investigation for the aforementioned allegation. LPA met licensee, Maria LPA observed 5 children ( 2 preschoolers and 3 infants) present. Licensee's assistant/son was also present.

Based upon the evidence obtained through the course of reviewing documentations and interviews, there is insufficient evidence to support or disprove that Staff hit child. Therefore, this allegation has been determined unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
An exit interview was conducted and a copy of this report was provided to the licensee.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2018
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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