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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197418922
Report Date: 11/15/2019
Date Signed: 11/05/2020 02:26:14 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
08/22/2019 and conducted by Evaluator Shandra Powell
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20190822090317
FACILITY NAME:PHAM FAMILY CHILD CAREFACILITY NUMBER:
197418922
ADMINISTRATOR:PHAM, TINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(424) 675-4403
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY:14CENSUS: 8DATE:
11/15/2019
UNANNOUNCEDTIME BEGAN:
11:07 AM
MET WITH:Tina Pham, LicenseeTIME COMPLETED:
12:50 PM
ALLEGATION(S):
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Personal Rights - Child was placed in closet while crying.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Shandra Powell conducted a complaint inspection to conclude the investigation in regards to the allegation that child was placed in closet while crying.

Based upon the evidence obtained through the course of reviewing documentations and interviews, there is insufficient evidence to support or disprove that Child was placed in closet while crying. Therefore, this allegation has been determined unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

An exit interview was conducted and a copy of this report will be provided via email to licensees.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019
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-20190822090317
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: PHAM FAMILY CHILD CARE
FACILITY NUMBER: 197418922
VISIT DATE: 11/15/2019
NARRATIVE
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This is an amended LIC9099-C reflecting the dismissed citation
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 30-CC-20190822090317
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: PHAM FAMILY CHILD CARE
FACILITY NUMBER: 197418922
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
CCR
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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: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019
LIC9099 (FAS) - (06/04)
Page: 3 of 3