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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197403006
Report Date: 11/14/2019
Date Signed: 11/14/2019 01:50:50 PM



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
10/31/2019 and conducted by Evaluator Margarit Sislyan
COMPLAINT CONTROL NUMBER: 30-CC-20191031151112
FACILITY NAME:OLMSTEAD FAMILY DAY CAREFACILITY NUMBER:
197403006
ADMINISTRATOR:OLMSTEAD, MAY A.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 385-1147
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91403
CAPACITY:14CENSUS: 3DATE:
11/14/2019
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:May OlmsteadTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Neglect/Lack of Supervision - Child wandered from facility
INVESTIGATION FINDINGS:
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Margarit Sislyan, Licensing Program Analyst (LPA) arrived at the facility to continue the investigation of the above allegation and deliver the investigation findings.
LPA met with Licensee and toured the facility. LPA observed there were 3 children present at the facility along with Licensee and her husband.
During the investigation LPA interviewed parties relevant to the allegation, obtained and reviewed police report.
Based on LPA's observation, interviews conducted and preponderance of evidence the above allegation is substantiated, means that the allegation is valid because the preponderance of the evidence standard has been met.
Licensee was cited Type A deficiency, according to California Code of Regulations Title 22 See 809D report for deficiencies. A copy of this report must be copied and given to all parents and to the parents of any child enrolling within the next 12 months.
Licensee is to post notice of Site Visit for 30 Days, failure to do so will result in $100 immediate civil penalty.
Exit interview
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Margarit SislyanTELEPHONE: (424) 430-3049
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019
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 30-CC-20191031151112
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: OLMSTEAD FAMILY DAY CARE
FACILITY NUMBER: 197403006
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/14/2019
Section Cited
CCR
102417(a)
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The licensee shall be present in the home and shall ensure that children in care are supervised at all times.

This requirement is not met as evidenced by: Licensee failed to provide supervision and 3 year old child wandered away and crossed the residential street.
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The licensee shall be present in the home and shall ensure that children in care are supervised at all times.

POC 11/14/19
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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.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Margarit SislyanTELEPHONE: (424) 430-3049
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 2