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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197401624
Report Date: 08/05/2024
Date Signed: 08/05/2024 12:37:35 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, 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
08/01/2024 and conducted by Evaluator Judy Laureano
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20240801113320
FACILITY NAME:TABAE FAMILY DAY CAREFACILITY NUMBER:
197401624
ADMINISTRATOR:TABAE, EFFATFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 571-1521
CITY:WEST LOS ANGELESSTATE: CAZIP CODE:
90025
CAPACITY:12CENSUS: 6DATE:
08/05/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Effat TabaeTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Ratio:Licensee is operating the facility out of ratio
INVESTIGATION FINDINGS:
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On 08/05/2024 Licensing Program Analyst (LPA) Judy Laureano arrived at above mentioned facility for the purpose of investigating the above-mentioned allegation. Upon arrival, LPA met with licensee, Effat Tabae, and discussed the purpose of the visit. LPA toured the facility and observed 6 children in care, sitting in chairs getting ready for snack time. Licensee confirmed that children were about to eat a snack.

LPA requested the following documents: children's roster and children’s file. LPA Laureano reviewed children’s file and verified children’s birthday based on documents reviewed. Licensee stated that she has one child attending as a drop in service and does not have any current documents for C6.

Based on documents reviewed and observation, licensee had a total 5 infants present during today's inspection 08/05/2024. Licensee verified dates of birth of all children present today and stated that C5 will be 2 in a couple of days (8/8/2024) Based on record review and licensee’s interview, there is a preponderance of evidence to prove the allegation of licensee operating out of ratio
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
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 30-CC-20240801113320
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: TABAE FAMILY DAY CARE
FACILITY NUMBER: 197401624
VISIT DATE: 08/05/2024
NARRATIVE
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did occur. Therefore, the allegation of Ratio is to be SUBSTANTIAED. Licensee was informed that she must come into capacity before the end of the inspection.

Per Title 22, Division 12, Chapter 1 regulations, for a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: Six children, no more than three of whom may be infants. LPA cited 1 deficiency cited during today’s visit in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1.

Effective January 1, 2009, all licensees must comply with Assembly Bill (AB) 978. Assembly Bill 978 requires the assessment of an immediate civil penalty for designated serious violations at community care facilities.
Effective January 1, 2007, the licensee must comply with Assembly Bill 633 as follows: Copies of any licensing report that documents a Type A citation - this includes facility visits and substantiated complaint investigations. Copies of any licensing documents pertaining to a noncompliance conference between licensing management and licensees. Copies of a summary of an accusation indicating the Department’s intent to revoke the facility’s licenses. Copies of any of the above licensing documents the licensee has
received in the prior 12 months shall be provided to parents/guardians of newly enrolling children. The licensee shall keep verification of receipt in each child’s file at the facility as proof of compliance (LIC 9224).

Upon on receipt of this report, the Licensee shall post the Notice of Site Visit. The Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.

An exit interview was conducted, and report was reviewed with Licensee Effat Tabae copy of this report and appeal rights were discussed and left with Licensee, whose signature on this form confirm receipt of these documents.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
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 30-CC-20240801113320
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: TABAE FAMILY DAY CARE
FACILITY NUMBER: 197401624
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/07/2024
Section Cited
CCR
102416.5(b)(2)
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(b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following:
(2) Six children, no more than three of whom may be infants; or
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Licensee agrees to review capacity requierment form and view How Many Children can attend a family child care home video and submit a statement of understanding to LPA.
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This requirement is not met as evidenced by:based on documents reviewed,observation
and licensee interview, licensee had a total 5 infants present during today's inspection,
08/05/2024.
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https://ccld.childcarevideos.org/family-child-care-providers/how-many-children-can-attend-a-family-child-care-home/
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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: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
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)
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