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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197493119
Report Date: 11/04/2021
Date Signed: 11/04/2021 04:51:35 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
09/08/2021 and conducted by Evaluator Denise Miranda
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20210908123428
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: 4DATE:
11/04/2021
UNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Mariana Rivera, Director TIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Admission Aggreement: Facility did not provide copy of admission agreement to child's authorized representative.
INVESTIGATION FINDINGS:
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On 11/04/2021 3:45PM, Licensing Program Analyst (LPAs) Denise Miranda and Carolyn Tuba conducted an unannounced visit at Le Petit Gan De Sophie Beverly Hills, located at 177 South Robertson Blvd, Beverly Hills, 90211, for the purpose of delivering the investigation findings the above-mentioned allegation. All adults present are associated to the facility. LPAs met with Mariana Rivera, Director and discussed the purpose of the visit. LPAs observed 04 children and 2 staff and Director during this inspection.
Based on the information gathered throughout the course of the investigation, the allegation that " Facility did not provide copy of admission agreement to child's authorized representative is substantiated, means that the allegation is valid because the preponderance of the evidences standard has been met. See LIC9099-D. An exit interview was conducted, and a copy of this report was provided to Mariana Rivera, Director.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
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 30-CC-20210908123428
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: 11/04/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/17/2021
Section Cited
CCR
101219.(c)
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The licensee shall keep the original copy of the admission agreement and give a photocopy to the child’s authorized representative. This requirement is not met as evidence by: Based on the information
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Facility will provide a signed copy of the admission agreement to the child’s authorized representative. A blank copy of the contract and addition, a copy of the admission agreement (pages: 11&12)
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 gathered, Facility failed to provide a sign copy of the admission agreemdent to the child’s authorized representative. This poses a potential health and safety risk to children in care.
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along with current of roster will be submit to LPA Miranda no later than 11/17/2021 via email.
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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: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
LIC9099 (FAS) - (06/04)
Page: 2 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
09/08/2021 and conducted by Evaluator Denise Miranda
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20210908123428

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: 4DATE:
11/04/2021
UNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Mariana Rivera, Director TIME COMPLETED:
05:00 PM
ALLEGATION(S):
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9
Personal Rights: Facility is accepting/retaining sick children.
INVESTIGATION FINDINGS:
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On 11/04/2021 3:45PM, Licensing Program Analyst (LPAs) Denise Miranda and Carolyn Tuba conducted an unannounced visit at Le Petit Gan De Sophie Beverly Hills, located at 177 South Robertson Blvd, Beverly Hills, 90211, for the purpose of delivering the investigation findings the above-mentioned allegation. All adults present are associated to the facility. LPAs met with Mariana Rivera, Director and discussed the purpose of the visit. LPAs observed 04 children and 2 staff and Director during this inspection.
Based on the information gathered throughout the course of the investigation which include LPA observation and interviews, the allegation above is unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there are not a preponderance of the evidences to prove that the alleged violation occurred. An exit interview was conducted, and a copy of this report was provided to Mariana Rivera, Director.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3