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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198010489
Report Date: 09/10/2020
Date Signed: 09/10/2020 06:01:40 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/17/2020 and conducted by Evaluator Katrina Chicote
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20200717130437
FACILITY NAME:CHAVARRIA FAMILY CHILD CAREFACILITY NUMBER:
198010489
ADMINISTRATOR:CHAVARRIA, ROSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 753-3644
CITY:LOS ANGELESSTATE: CAZIP CODE:
90003
CAPACITY:14CENSUS: 0DATE:
09/10/2020
UNANNOUNCEDTIME BEGAN:
05:15 PM
MET WITH:Rosa Chavarria, LicenseeTIME COMPLETED:
06:15 PM
ALLEGATION(S):
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Licensee pulled child’s hair.
Child sustained unexplained injury while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Katrina Chicote conducted an unannounced complaint tele-inspection via FaceTime on 09/10/2020 at 5:15 PM, to investigate the above allegations. LPA toured facility with Licensee, Rosa Chavarria, Licensee’s granddaughter was also present during time of inspection and assisting with English-Spanish translation. There were no children present during this visit.

During the course of this investigation, LPA interviewed Reporting Parties (RPs), Licensee, Licensee's Assistant, parents, children, and social worker. All pertinent documentation was collected. No corroborating disclosures were made regarding the above allegations from interviews conducted.

Although the allegations may have happened or are valid there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

Report Continues Next Page - Page 1 of 2
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2020
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 54-CC-20200717130437
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CHAVARRIA FAMILY CHILD CARE
FACILITY NUMBER: 198010489
VISIT DATE: 09/10/2020
NARRATIVE
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No deficiencies will be cited today.

The Notice of Site Visit (LIC 9213) – 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 Rosa Chavarria, Licensee, including, but not limited to Appeal Procedures and Agencies Consultative Role.
Report Ends - Page 2 of 2
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2