<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197492991
Report Date: 08/25/2021
Date Signed: 08/25/2021 12:03:22 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
06/25/2021 and conducted by Evaluator Silva Garibyan
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20210625141142
FACILITY NAME:SAHIN FAMILY CHILD CAREFACILITY NUMBER:
197492991
ADMINISTRATOR:SAHIN, NICOLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(747) 529-6272
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY:14CENSUS: 3DATE:
08/25/2021
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Nicole Sahin/LicenseeTIME COMPLETED:
10:10 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
 Neglect/Lack of Supervision: Licensee did not ensure that infant in care was supervised appropriately


INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Silva Garibyan conducted a visit to the facility for the purpose of delivering the findings on the above allegations LPA met with Nicole Sahin, Licensee at 8:00 a.m on 08/25/2021 Licensee was present with three children ( including one infant).

Based upon the evidence obtained through the course of investigation which include observations at the facility, interview with relevant parties there is insufficient evidence to support or disprove that Licensee did not ensure that infant in care was supervised appropriately. 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.
An exit interview was conducted and a copy of this report was provided.
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: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
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
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
06/25/2021 and conducted by Evaluator Silva Garibyan
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20210625141142

FACILITY NAME:SAHIN FAMILY CHILD CAREFACILITY NUMBER:
197492991
ADMINISTRATOR:SAHIN, NICOLEFACILITY TYPE:
810
ADDRESS:14824 KINZIE STREETTELEPHONE:
(747) 529-6272
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY:14CENSUS: 3DATE:
08/25/2021
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Nicole Sahin/LicenseeTIME COMPLETED:
10:10 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Reporting Requirements: Child sustained injury that resulted in medical attention. Licensee did not report to CCLD as unusual incident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13


Based on the information obtained, the above allegation is substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. An exit interview was conducted and a copy of this report was provided.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 30-CC-20210625141142
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: SAHIN FAMILY CHILD CARE
FACILITY NUMBER: 197492991
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/25/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/08/2021
Section Cited
CCR
102416.2(d)(2)
1
2
3
4
5
6
7
Reporting Requirements: The licensee shall report to the Department as provided by the Health and Safety Code Section 1597.467(b)(1) and (2). In addition to the report required pursuant to paragrah (1), a written report shall be submitted to the Department within seven days following the occurrence of such
1
2
3
4
5
6
7
LPA informed licensee of required reporting requirements. The importance of telephoning the incident and following up with the required written report. Licensee will provide LPA with a written statement indicating she will ensure that any unusual incidents are reported as required.
8
9
10
11
12
13
14
 event. This requirement is not met as evidenced: On 6/24/21 child sustained injury that resulted in medical attention. Licensee did not report to CCLD as unusual incident.
This is a type B dificiency as poses a potential risk to the health and safety of children in care
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3