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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197494051
Report Date: 01/25/2024
Date Signed: 01/25/2024 02:46:50 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 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
10/27/2023 and conducted by Evaluator Joe Katrdzhyan
PUBLIC
COMPLAINT CONTROL NUMBER: 58-CC-20231027143641
FACILITY NAME:DVALISHVILI FAMILY CHILD CAREFACILITY NUMBER:
197494051
ADMINISTRATOR:DVALISHVILI, DALIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 788-1024
CITY:TARZANASTATE: CAZIP CODE:
91356
CAPACITY:14CENSUS: 7DATE:
01/25/2024
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Director / Dali DvalishviliTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility is not maintained clean.
INVESTIGATION FINDINGS:
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On 1/24/24, at 12:45PM, Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an unannounced visit to this facility to deliver findings on the above-mentioned allegation of “Facility is not maintained clean”. Upon arrival, LPA met with Licensee / Dali Dvalishvili, who guided LPA on a tour of the facility. There were 7 children with 2 staff observed present. LPA explained the purpose of today’s visit.

During the course of the investigation, interviews were conducted and copies of Children / Staff Rosters were obtained / reviewed and pictures taken.

Per Reporting Party, the facility is not maintained clean and sanitary.

During the interview with the Licensee, it was disclosed that the inside of the facility is wiped daily and the toys are washed once a week. The outside toys/equipment and play area is also cleaned daily to insure the health and safety of the children.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Joe KatrdzhyanTELEPHONE: (424) 301-3049
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024
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 5
Control Number 58-CC-20231027143641
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DVALISHVILI FAMILY CHILD CARE
FACILITY NUMBER: 197494051
VISIT DATE: 01/25/2024
NARRATIVE
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During the visit conducted on 11/2/23, a walk through of the facility was conducted by the LPA and Licensee and the following was observed / pictures taken.

Bathroom designated for children: Clutter (such as boxes full of miscellaneous items) were observed piled on top of the bathtub. Toys (such as a washer/dryer), a stroller, desk, stuffed animal and floor mats were also observed piled on top of the bathtub making it a hazard for children. A box full of diapers was observed on the bathroom floor making it a tripping hazard for children.
Family Room: The family room (which is on-limit and used as an isolation/napping area) was observed to have a wheelchair, bags full of miscellaneous items, boxes and yoga mats on the floor.
Outside Play Area: The outside toys were observed to have dust, dirt and leaves on them, making it unsanitary for the kids.

Based on LPA’s observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, (Title 22, Division & Chapter number), is being cited on the attached LIC 9099D.

The Notice of Site Visit was provided and must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Natasha Madison and Leighann Ballton and Appeals Rights provided.

SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Joe KatrdzhyanTELEPHONE: (424) 301-3049
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 58-CC-20231027143641
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: DVALISHVILI FAMILY CHILD CARE
FACILITY NUMBER: 197494051
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/25/2024
Section Cited
CCR
102417(b)
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Operation of a Family Child Care Home. The home shall be kept clean and orderly, with heating and ventilation for safety and comfort. This requirement is not met as evidenced by: During the visit conducted on 11/2/23, a walk through of the facility was conducted by the LPA and Licensee and
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During today's visit LPA did a walk through of the facility and observed the clutter inside the bathroom and family room had been cleaned and out away. The outside play area was also observed to be clean and sanitary.
No further action is needed.
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the following was observed / pictures taken. Bathroom designated for children: Piles of clutter (such as boxes full of miscellaneous items) were observed sitting on top of the bathtub. Toys (such as a washer/dryer), a stroller, desk, stuffed animal and floor mats were also observed piled on top of the bathtub making it a hazard for children. A box full of diapers was observed on the bathroom floor making it a tripping hazard for children. Family Room: The family room (which is on-limit and used as an isolation/napping area) was observed to have a wheelchair, bags full of miscellaneous items, boxes and yoga mats on the floor. Outside Play Area: The outside toys were observed to have dust, dirt and leaves on them, making it unsanitary for the kids. This poses a potential health, safety, and personal rights to children 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: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Joe KatrdzhyanTELEPHONE: (424) 301-3049
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 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
10/27/2023 and conducted by Evaluator Joe Katrdzhyan
PUBLIC
COMPLAINT CONTROL NUMBER: 58-CC-20231027143641

FACILITY NAME:DVALISHVILI FAMILY CHILD CAREFACILITY NUMBER:
197494051
ADMINISTRATOR:DVALISHVILI, DALIFACILITY TYPE:
810
ADDRESS:5926 CORBIN AVENUETELEPHONE:
(323) 788-1024
CITY:TARZANASTATE: CAZIP CODE:
91356
CAPACITY:14CENSUS: 7DATE:
01/25/2024
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Director / Dali DvalishviliTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Licensee does not separate children who show signs of illness.
INVESTIGATION FINDINGS:
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On 1/24/24, at 12PM, Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an unannounced visit to this facility to deliver findings on the above-mentioned allegation of “Licensee does not separate children who show signs of illness”. Upon arrival, LPA met with Licensee / Dali Dvalishvili, who guided LPA on a tour of the facility. There were 7 children with 2 staff observed present. LPA explained the purpose of today’s visit.

During the course of the investigation, interviews were conducted and copies of Children / Staff Rosters were obtained / reviewed and pictures taken.

Per Reporting Party, Licensee does not separate children who show signs of illness.

During the interview with the Licensee, it was disclosed that when a child becomes ill and poses a threat to the health and safety of other children or staff, the child is separated from the group into the isolation, which is the Family Room and the parent(s) of the ill child is notified and the child is sent home. When a child
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Joe KatrdzhyanTELEPHONE: (424) 301-3049
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 58-CC-20231027143641
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DVALISHVILI FAMILY CHILD CARE
FACILITY NUMBER: 197494051
VISIT DATE: 01/25/2024
NARRATIVE
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is seen by a doctor, the parent(s) is asked to provide a doctor’s note clearing the child back to the daycare. This information is also listed in the Parent-Provider Contract and a copy of this contract is provided to the parent(s), at the time of admission. The Licensee denied the allegation of not separating children who show signs of illness.

During the interview with staff, the statements obtained corroborated with the statements obtained from the Licensee. Per staff, when a child becomes ill, staff notifies the Licensee and the Licensee separates the child from the group into the isolation room (Family Room) and the parent(s) of the ill child is notified. A staff member stays with the child in the isolation room until the child is picked up and sent home.

Parents interviewed did not present concerns related to the above-mentioned allegation and were pleased with the services and care being provided to their children.

Based on the investigation conducted, there is insufficient evidence to support the above-mentioned allegation to be true. Therefore, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

The Notice of Site Visit was provided and must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Dali Dvalishvili and Appeals Rights provided.

SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Joe KatrdzhyanTELEPHONE: (424) 301-3049
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5