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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198013606
Report Date: 10/26/2021
Date Signed: 10/26/2021 02:58:02 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/12/2021 and conducted by Evaluator Mireya Garcia
COMPLAINT CONTROL NUMBER: 33-CC-20210812111704
FACILITY NAME:PILAVIAN FAMILY CHILD CAREFACILITY NUMBER:
198013606
ADMINISTRATOR:PILAVIAN, SONIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 216-9068
CITY:LOS ANGELESSTATE: CAZIP CODE:
90039
CAPACITY:14CENSUS: 9DATE:
10/26/2021
UNANNOUNCEDTIME BEGAN:
01:08 PM
MET WITH:Sonia Pilavian, LicenseeTIME COMPLETED:
03:10 PM
ALLEGATION(S):
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Licensee is not wearing masks
Day care children are not wearing masks
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mireya García arrived unannounced at the facility for the purpose of conducting a follow up complaint investigation to deliver findings regarding the allegations listed above. Due to COVID- 19 precautionary measures were taken, licensing staff present during inspection wore appropriate personal protective equipment. LPA met with Licensee, Sonia Pilavian who guided LPA on a tour of the facility. There were nine (9) children observed to be present at the facility during this inspection. Also present was Licensee’s assistant Daynery Hernandez.

Information provided by the complainant alleges that Licensee and day care children were not wearing masks before 09/02/2021.

REPORT CONTINUES ON NEXT PAGE 1 OF 3.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
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 5
Control Number 33-CC-20210812111704
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PILAVIAN FAMILY CHILD CARE
FACILITY NUMBER: 198013606
VISIT DATE: 10/26/2021
NARRATIVE
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During this investigation LPA M. García obtained copies of Children’s roster dated 05/28/2021, Official Inspection Report from the Department of Public Health dated 08/24/2021, COVID- 19 Outbreak clearance letter dated 09/02/2021 from the Department of Public Health, and conducted interviews with Licensee, Assistant and ten (10) day care parents.

Pertaining to the allegation that the Licensee does not wear a mask, statements from day care parents confirm on occasion that the Licensee was observed not wearing face mask when talking to parents. In addition, Staff disclosed not wearing face mask when being inside and outside of the home while providing care and supervision to day care children. When Licensee was asked about day care staff not wearing a face mask while the children were in care, Licensee confirmed and disclosed she was not going out and was taking care of self.

Regarding to the allegation that day care children are not wearing masks. Interview with day care staff reveal that some day care children ages 2 and older were not wearing face masks inside and outside of the home. Interviews conducted with day care parents confirm observing day care children not wearing masks while at the facility. Based on LPAs interviews which were conducted, and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. California Code of Regulations, Title 22, Division 12, Chapter 1, the following deficiencies are being cited (see attached 9099D).

REPORT CONTINUES ON NEXT PAGE 2 OF 3.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 33-CC-20210812111704
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PILAVIAN FAMILY CHILD CARE
FACILITY NUMBER: 198013606
VISIT DATE: 10/26/2021
NARRATIVE
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A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). Acknowledgement of Receipt (LIC 9224 form) must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form (English/Spanish).

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Licensee, Sonia Palivian.

END OF REPORT: PAGE 3 OF 3.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 33-CC-20210812111704
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PILAVIAN FAMILY CHILD CARE
FACILITY NUMBER: 198013606
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/26/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/27/2021
Section Cited
CCR
102423(a)(2)
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102423-Personal Rights: (a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement is not met as evidenced by:
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Per Licensee, she will continue to follow COVID-19 requirements and guidance of Community Care Licensing Department, Provider Information Notice, CDPH, Cal/OSHA, and local public health department. In addition, Licensee will apply any new and updated policies and requirements that address the need for continued infection control. Licensee will submit compliance plan in writing to LPA Garcia via email on 10/27/2021 in order to clear this citation.
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Disclosures made by staff and day care parents revealed that Sonia Pilavian and Daynery Hernandez did not wear face coverings while in the facility prior to 09/02/21, as required by the CA Dept. of Public Health Guidance on the Use of Face Coverings issued June 18, 2020 and updated July 28, 2021, and an individual mask exception did not apply.
The licensee did not ensure the personal rights of persons in care to safe and healthful accommodations and engaged in conduct inimical to the health, welfare, and safety of persons in care, in that facility staff, this poses an immediate health and safety risk 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: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 33-CC-20210812111704
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PILAVIAN FAMILY CHILD CARE
FACILITY NUMBER: 198013606
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/26/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/27/2021
Section Cited
CCR
102423(a)(2)
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102423-Personal Rights: (a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement is not met as evidence by:
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Per Licensee, she will continue to follow COVID-19 requirements and guidance at the facility. In addition, Licensee and day care staff will model, teach and remind day care children aged 2 and older to wear face coverings while at the facility. In addition, Licensee has face coverings readily available for children if needed a mask will be provided. Licensee will submit compliance plan in writing to LPA Garcia via email on 10/27/2021 in order to clear this citation.
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Disclosures made by staff and day care parents revealed that some day care children ages 2 and older did not wear face coverings while inside and outside of the facility prior to 09/02/21, as required by the CA Dept. of Public Health Guidance on the Use of Face Coverings issued June 18, 2020 and updated July 28, 2021, and an individual mask exception did not apply.
The licensee did not ensure the personal rights of persons in care to safe and healthful accommodations and engaged in conduct inimical to the health, welfare, and safety of persons in care, in that facility staff, this poses an potential health and safety risk 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: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5