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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197409619
Report Date: 06/12/2019
Date Signed: 06/14/2019 09:14:32 AM



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
06/11/2019 and conducted by Evaluator Silva Garibyan
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20190611093507
FACILITY NAME:ACOSTA FAMILY CHILD CAREFACILITY NUMBER:
197409619
ADMINISTRATOR:ACOSTA, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 506-0818
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY:14CENSUS: 15DATE:
06/12/2019
UNANNOUNCEDTIME BEGAN:
07:50 AM
MET WITH:Maria AcostaTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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License: Facility operating out of ratio
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Silva Garibyan, conducted a complaint visit regarding the above mentioned allegation. LPA Garibyan met with licensee, Maria Acosta, and toured the home on June 12, 2019 at 7:30 a.m.. There were 15 children ( including two infants, four school age children, and nine preschoolers) present at the time of the visit. Licensee was present with her two assistants ( licensee's husband and daughter).
Based on the information obtained from the interviews conducted and observations by the LPA, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, Title 22, Division 12, Chapter 1, Article 06, Section 102416.5 (d)(2) is being cited on the attached LIC 9099D page. Type A deficiency cited. Copy of report, 9099D, Appeal Rights, LIC9224 and Notice of Site visit issued. A copy of this report will be posted for 30 days, a copy given to the parents of each child enrolled and the parent of any child that enrolls for 12 months.
Exit interview was conducted.



Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2019
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 3
Control Number 30-CC-20190611093507
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: ACOSTA FAMILY CHILD CARE
FACILITY NUMBER: 197409619
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/12/2019
Section Cited
CCR
102416.5(d)(2)
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Staffing Ratio and Capacity. The capacity specified on the license shall be the maximum number of children for whom care can be provided.
This requirement is not met as evidenced by: 15 children were present ( including two infants, four school age children, and nine preschoolers) at the time of the visit.
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Licensee will submit a declaration stating that the facility will operate within the terms of the license at all times.
Licensee agrees to reduce her capacity effective immediately. Licensee will submit a current Roster to CCL with the names of the children who are still enrolled at the facility.
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This is a type A violation and it poses an immediate risk to the health and safety of children in care.
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Licensee will give notice to the parent of the child who will no longer attend care at the facility and submit copy of the letter to CCL by 06/19/2019.
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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: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2019
LIC9099 (FAS) - (06/04)
Page: 3 of 3