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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197419791
Report Date: 10/26/2022
Date Signed: 10/26/2022 12:00:58 PM

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
10/17/2022 and conducted by Evaluator Justin Dorsey
COMPLAINT CONTROL NUMBER: 12-CC-20221017114815
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: 4DATE:
10/26/2022
UNANNOUNCEDTIME BEGAN:
10:16 AM
MET WITH:Adriana GianiTIME COMPLETED:
12:14 PM
ALLEGATION(S):
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Uncleared adult residing in the home
INVESTIGATION FINDINGS:
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On 10/26/22 Licensing Program Analyst (LPA) Justin Dorsey conducted a complaint investigation at the facility to deliver complaint investigation findings. LPA met with Adriana Giani, who allowed LPA to tour all areas of the home. Upon arrival LPA observed 4 children with 2 staff members.

During this investigation, LPA received documents related to this investigation, which included the facility children’s roster and a children's sign in sheet from 10/21/22. LPA also interviewed the complainant, licensee, and a child of the program. Upon arrival LPA Dorsey observed uncleared Adult #1 leaving the RV in front of the home and going into the homes front yard through the gate. LPA Dorsey later observed uncleared Adult #1 coming back out of the homes front yard throught the gate carrying a yellow and black tool bag. Based on information obtained, interviews with complainant, licensee, and a child the allegations are deemed SUBSTANTIATED and a Type A citation and $500 immediate civil penalty will be issued. A finding of substantiated means that allegations were valid because the preponderance of the evidence standard has been met.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
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-20221017114815
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
VISIT DATE: 10/26/2022
NARRATIVE
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Applicant advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.


During the visit LPA Dorsey was experiencing printer problems. LPA Dorsey provided licensee with a written LIC 809. LPA Dorsey read Licensee Adriana Giani the report and emailed licensee a copy of the LIC 809, Notice of Site Visit and Appeal Rights.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 12-CC-20221017114815
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: 10/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/31/2022
Section Cited
CCR
102370(d)(1)
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102370 Criminal Record Clearance (d)(1) All individuals...shall prior to working, residing, or volunteering in a licensed facility...Obtain a California clearance or a criminal record exemption as required by the Department...This requirement is not met as evidenced by:
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LIcensee will write a plan on how she will keep uncleared Adult #1 off of the homes property and ensure that uncleared Adult #1 does not come on the homes property by POC due date 10/31/22.
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Based on observation uncleared Adult #1 accesses the homes front yard when children are present, which poses an immediate Health, Safety or Personal Rights risk to children 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.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC9099 (FAS) - (06/04)
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