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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197416054
Report Date: 11/19/2020
Date Signed: 11/19/2020 01:35:31 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
10/02/2020 and conducted by Evaluator Margarit Sislyan
COMPLAINT CONTROL NUMBER: 30-CC-20201002163951
FACILITY NAME:KIDS PARK NORTHRIDGE (SA)FACILITY NUMBER:
197416054
ADMINISTRATOR:ROSS, DAVIDAFACILITY TYPE:
840
ADDRESS:9056 TAMPA AVENUETELEPHONE:
(818) 998-5437
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY:25CENSUS: 15DATE:
11/19/2020
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Jamie ChastainTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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9
Lack of supervision - Staff did not prevent inappropriate interactions between children resulting in injury
Level of Care - Staff did not seek medical attention for child in a timely manner
INVESTIGATION FINDINGS:
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Margarit Sislyan, Licensing Program Analyst (LPA) conducted tele-visit to deliver the investigation findings of the above allegation. LPA spoke with Jaime Chastain, Director.
As a result of the interviews conducted and records acquired during the investigation, there is no evidence that staff did not prevent inappropriate interactions between children resulting in injury and staff did not seek medical attention for child in a timely manner
Based on the evidence obtained and reviewed, the department has determined that the allegation is unsubstantiated, means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
Licensee has been advised that an email shall be sent with the report attached, which has been reviewed during the Tele-Visit and a read receipt via email shall be considered an acknowledgement that they are in receipt of this form.

Exit interview
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Margarit SislyanTELEPHONE: (424) 430-3049
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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