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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197493119
Report Date: 09/13/2019
Date Signed: 09/13/2019 01:35:45 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
06/21/2019 and conducted by Evaluator Peter Flores
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20190621134618
FACILITY NAME:LE PETIT GAN DE SOPHIE BEVERLY HILLS, LLCFACILITY NUMBER:
197493119
ADMINISTRATOR:MARIANA RIVERAFACILITY TYPE:
850
ADDRESS:177 SOUTH ROBERTSON BLVD.TELEPHONE:
(310) 499-8615
CITY:BEVERLY HILLSSTATE: CAZIP CODE:
90211
CAPACITY:65CENSUS: DATE:
09/13/2019
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:TIME COMPLETED:
01:55 PM
ALLEGATION(S):
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OTHER: Facility failed to abide by admission agreements.
INVESTIGATION FINDINGS:
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On 9/13/19 at 12:45 PM, Licensing Program Analysts (LPA) Peter Flores conducted a subsequent inspection to Le Petit Gan De Sophie Beverly Hills, for the purpose of concluding a complaint investigation. LPA met with Director Mariana Rivera and informed the nature of the visit.

Based on LPAs observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12, Chapter 1, and Article 6 are being cited on the attached LIC 9099D.

An exit interview was conducted, and a copy of this report was given to Director Mariana Rivera.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2019
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 2
Control Number 30-CC-20190621134618
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: LE PETIT GAN DE SOPHIE BEVERLY HILLS, LLC
FACILITY NUMBER: 197493119
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
09/13/2019
Section Cited
CCR
101219(f)
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ADMISSION AGREEMENTS: The licensee shall comply with all terms and conditions set forth in the admission agreement.
Family was charged a 60 day withdrawal fee with no Notice of withdrawl fee on file.
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Facility agrees to follow the terms and condtions set forth in the addmission agreement. Facility will submit a statement ensuring that the terms and codnitions of the addmission agreement are met to the Department by 09/18/2019.
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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: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 2