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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198013477
Report Date: 06/23/2021
Date Signed: 06/23/2021 11:47:43 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/28/2021 and conducted by Evaluator Monique Jessica Ayala
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20210528084809
FACILITY NAME:MIRZAYAN FAMILY CHILD CAREFACILITY NUMBER:
198013477
ADMINISTRATOR:MIRZAYAN, HASMIKFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 631-5259
CITY:SUNLANDSTATE: CAZIP CODE:
91040
CAPACITY:14CENSUS: 12DATE:
06/23/2021
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Hasmik Mirzayan, LicenseeTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights: Licensee inappropriately handled children in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 06/23/2021 Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced complaint investigation for the above allegation at 10:45am, LPA was greeted by licensee. LPA toured the facility and gathered the census of children present. There were 12 children in care with the supervision of the licensee and her assistant.

The investigation consisted of interviews conducted with Licensee, Licensee’s assistant, children, and other relevant complaint parties. The interviews revealed that there were no witnesses that could corroborate that the provider inappropriately handeled children in care. Based on the evidence obtained the above allegation is deemed UNSUBSTANTIATED.

An exit interview was conducted and a copy of this report was provided to the licensee along with Notice of Site Visit and Appeal Rights.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 369-2168
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: (661) 202-3365
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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