197416491-6-3-2021-30-CC-MRUZ-C3MKGN-20210603075348

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197416491
Report Date: 06/01/2021
Date Signed: 06/03/2021 07:46:42 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
04/29/2021 and conducted by Evaluator Margarit Sislyan

PUBLIC

COMPLAINT CONTROL NUMBER: 30-CC-20210429112815

FACILITY NAME:	SHALOM FAMILY CHILD CARE		FACILITY NUMBER:	197416491
ADMINISTRATOR:	BOOKOVZA, RACHEL S.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 881-1625
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	14	CENSUS: 5	DATE:	06/01/2021
		UNANNOUNCED	TIME BEGAN:	03:53 PM
MET WITH:	Rachel Bookovza		TIME COMPLETED:	04:55 PM

ALLEGATION(S):

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Personal Rights - Licensee hit day care Children
Personal Rights - Child sustained injuries while in care
Personal Rights - Licensee speaks inappropriately to children

INVESTIGATION FINDINGS:

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Margarit Sislyan, Licensing Program Analyst (LPA) conducted a tele-visit via Face-Time to deliver the investigation findings. LPA met with Licensee, Rachel Bookovza. Tele-tour was conducted. LPA observed 5 children were present at home.

The complaint was referred to IB unit for investigation.

Based on results of IB investigation and preponderance of evidence the above allegations are unsubstantiated.
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 Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Margarit Sislyan	TELEPHONE: (424) 430-3049
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2021

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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