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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197419791
Report Date: 06/23/2021
Date Signed: 06/25/2021 08:42:37 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/20/2021 and conducted by Evaluator Carol Heath
COMPLAINT CONTROL NUMBER: 12-CC-20210520140945
FACILITY NAME:GIANI FAMILY CHILD CAREFACILITY NUMBER:
197419791
ADMINISTRATOR:GIANI, ADRIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 364-2228
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:14CENSUS: 10DATE:
06/23/2021
UNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Morena GironTIME COMPLETED:
02:40 PM
ALLEGATION(S):
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Day care child sustained injury while in care
INVESTIGATION FINDINGS:
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On June 24, 2021, Licensing Program Analyst (LPA) Carol Heath conducted a follow-up complaint inspection to the Giani Family Child Care and met with the licensee assistant, Morena Giron. The purpose of the inspection was to deliver findings for the above Complaint allegation. On May 19, 2021, child #1 sustained an injury to the head causing a cut while in the license childcare facility. The licensee failed to provide chid an appropriate level of supervision which resulted in child sustainint injuries to his head.

Based on observations, physical evidence and interviewsthe information obtained, there is a preponderance of the evidence to prove that the licensee did not observe the incident. Therefore, the above allegation is found to be SUBSTANTIATED. This facility is being cited for Type A deficiency.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021
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 12-CC-20210520140945
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: GIANI FAMILY CHILD CARE
FACILITY NUMBER: 197419791
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/23/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/24/2021
Section Cited
CCR
101229(a)(1)
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101229 Responsibility for Providing Care and Supervision:(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any
time, except as specified in Sections 101216.2
(e)(1) and 101230(c)(1).
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I will call my assistants to come outside or bring me the materials. I will not leave children by themselve.
Also I will bring all the children inside if I need to go inside.
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This requirement is not met as evidence by: Based on observations, physical evidence and interviews the licensee did not provide appropriate adult supervision which cause a child #1 hasa sustantiated injury.
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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.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021
LIC9099 (FAS) - (06/04)
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