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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197419791
Report Date: 06/23/2021
Date Signed: 06/25/2021 08:44:36 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/20/2021 and conducted by Evaluator Carol Heath
COMPLAINT CONTROL NUMBER: 12-CC-20210520140945
FACILITY NAME:GIANI FAMILY CHILD CAREFACILITY NUMBER:
197419791
ADMINISTRATOR:GIANI, ADRIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 364-2228
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:14CENSUS: DATE:
06/23/2021
UNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:GIANI, ADRIANATIME COMPLETED:
02:40 PM
ALLEGATION(S):
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Licensee did not notify day care child's authorized representative of injury in a timely manner
INVESTIGATION FINDINGS:
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On June 24, 2021, Licensing Program Analyst (LPA) Carol Heath conducted a follow-up complaint inspection to the Giani Family Child Care and met with the licensee assistant Morena Giron. The purpose of the inspection was to deliver findings for the above complaint allegation. On May 19, 2021, child #1 sustained an injury to the head causing a cut while in the licensed childcare facility. The licensee failed to notify the licensing department and parents of the injury.
Based on LPA observations, physical evidence and interviews, it was determined that the licensee failed to report CCLD and child’s parent regarding the incident that occurred within the facility. When the licensee was informed about the injury to the child’s head, the licensee did not notify the Department by telephone or in writing within the mandated timeframe.
Based on the information obtained, there is a preponderance of the evidence to prove that the licensee failed to meet the reporting requirements. Therefore, the above allegation is found to be SUBSTANTIATED. Appeal Rights were provided and discussed with the Licensee and deficiencies were cited.
Exit interview conducted and a copy of the report was left with the Licensee.
Type B deficiencies are being cited. See LIC 9099 D for deficiencies.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021
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 12-CC-20210520140945
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: GIANI FAMILY CHILD CARE
FACILITY NUMBER: 197419791
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/23/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/24/2021
Section Cited
CCR
102416.2(f)(1)
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Reporting Requirements: 102416.2(f)(1) Any injury suffered by a child in care shall be reported to that child's parent or authorized representative regardless of treatment by a medical professional.
This requirement is not met as evidence by:
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Call the parent immediately to notify of incident and what care has bee provided.

Document all incidents and obtain written acknowledgement from the parent or authorized adult picking up the child.

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 Based on observation and and interviews,the licensee did not call the child's parents to let them know the incident and the treatment, which posed a potential Health, Safety or Personal Rights risk to persons in care.
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Type B
06/24/2021
Section Cited
CCR
102416.2(d)(1)
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Reporting Requirements: 102416.2(d)(1) A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home of…the…events."
This requirement is not met as evidenced by:
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Call my LPA to report the incident. Send incident report to licensing case worker and file for my own records.
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Based on observation, interviews and record review, the licensee did not report to Palmdale Regional Office about this injure which poses a potential Health, Safety or Personal Rights risk to persons in care.
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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: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3