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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197416878
Report Date: 06/21/2021
Date Signed: 06/22/2021 06:57:31 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
04/15/2021 and conducted by Evaluator Silva Garibyan
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20210415121205
FACILITY NAME:MINWALLA FAMILY CHILD CAREFACILITY NUMBER:
197416878
ADMINISTRATOR:MINWALLA, SHAMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 801-8155
CITY:LOS ANGELESSTATE: CAZIP CODE:
90019
CAPACITY:14CENSUS: 6DATE:
06/21/2021
ANNOUNCEDTIME BEGAN:
02:32 PM
MET WITH:Shama Minwalla/licenseeTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
This report is being delivered electronically per Tele-Visits Procedure for COVID-19.
Licensing Program Analyst (LPA), Silva Garibyan met with the licensee, Shama Minwalla via Facetime, for the purpose of delivering the findings on the above allegation on 06/21/2021 at 2:30 PM.
Based upon the evidence obtained through the course of reviewing documentations and interviews, there is insufficient evidence to support or disprove the above allegation. Therefore, this allegation has been determined unsubstantiated. A finding that the complaint 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 was advised that an email will be sent with the report attached, which has been reviewed during the Tele-Visit. Licensee was further advised that a read receipt via email shall be considered an acknowledgement that she is in receipt of this form and understands her licensing appeal rights as explained.
An exit interview was conducted and a copy of this report will be provided via email to licensee.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2021
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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