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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197419197
Report Date: 10/03/2019
Date Signed: 10/03/2019 12:15:07 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
07/19/2019 and conducted by Evaluator Margarit Sislyan
COMPLAINT CONTROL NUMBER: 30-CC-20190719094248
FACILITY NAME:A MOTHER GOOSE ACADEMYFACILITY NUMBER:
197419197
ADMINISTRATOR:JOHNSON, ELIZABETHFACILITY TYPE:
850
ADDRESS:11849 BURBANK BLVD.TELEPHONE:
(818) 980-0118
CITY:VALLEY VILLAGESTATE: CAZIP CODE:
91607
CAPACITY:41CENSUS: 31DATE:
10/03/2019
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Victoria MarguletaTIME COMPLETED:
12:30 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
Margarit Sislyan, Licensing Program Analyst (LPA) arrived to the facility to continue the investigation of the above allegation and deliver the investigation findings.
LPA met with DIrector, Victoria Marguleta.

LPA observed 31 children and 4 teachers were present.
During the investigation LPA interviewed parties, and reviewed documents relevant to the allegation.

Based on LPA’s observatio, n, interviews’ conducted and preponderance of evidence the above 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.

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: 10/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019
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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