Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198012439
Report Date: 04/06/2017
Date Signed 04/06/2017 09:01:23 AM


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/27/2017 and conducted by Evaluator Anomeh Eivazian
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20170227093746
FACILITY NAME:KIDZHAVENFACILITY NUMBER:
198012439
ADMINISTRATOR:CHAMPA S. PERERAFACILITY TYPE:
850
ADDRESS:9052 & 9052 1/2 SUNLAND BLVD.TELEPHONE:
(818) 767-2623
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY:33CENSUS: 14DATE:
04/06/2017
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Champa S. PereraTIME COMPLETED:
09:10 AM
ALLEGATION(S):
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Physical Abuse/Corporal Punishment-- Staff interacted with child in a physically inappropriate manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced complaint inspection to deliver above allegation finding. LPA met with Director, Champa S. Perera who guided analyst on a tour of the facility. There were 14 children present during this inspection.

An investigation was conducted regarding the complaint allegation listed above. During the course of the investigation interviews were conducted with Complainant, Director, Teaching Staff, Children, Victim, Victim’s Parents, and Parents of children currently enrolled at the facility. A copy of Police report was obtained on 03/01/17.

There were no disclosures made by Director, teaching staff, children, parents of children currently enrolled, and victim’s mother.
REPORT CONTINUES ON NEXT PAGE 1 OF 2
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2017
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 2



Control Number 33-CC-20170227093746
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: KIDZHAVEN
FACILITY NUMBER: 198012439
VISIT DATE: 04/06/2017
NARRATIVE
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Based on Police report, Officer #1 attempted to speak with Victim but victim was shy and would only talk to father. Victim's father stated that victim told father that teacher #1 pulled child’s ear (touching the base of right ear with right hand) and pulled child’s hair because child was bad and it hurt the child and made the child to cry. Victim indicated that teacher #1 had pulled child’s ear approximately 10 times in the past, showing both of her hands.
Officer #2 inspected victim for injuries. Observed slight redness to both of victim’s arm pits which victim stated were itchy as well as redness on victim’s right outer leg which victim indicate scratched, because it was itchy.

Based on an interview conducted with victim’s father, on 02/24/17 victim looked kind of sad, and victim’s father asked what was wrong, victim stated: Daddy I do not want to go to the school, because teacher pulled my hair and ear, and I cried once. Victim’s father has not talked to school in this regards. Victim still is attending to this school.

LPA conducted two interviews with victim, one interview at the facility and one interview in the victim’s home. No disclosure was made by victim.

Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time.

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 conducted with Champa S. Perera, Director, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role

REPORT END 2 of 2
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2017
LIC9099 (FAS) - (06/04)
Page: 2 of 2