214200040-7-7-2021-05-CC-GLEG-C4PU88-20210707152106

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 214200040
Report Date: 07/07/2021
Date Signed: 07/07/2021 11:55:47 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/09/2021 and conducted by Evaluator Farhan Bashir-Tariq

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20210409152828

FACILITY NAME:	CHIOVAROU, MAURA		FACILITY NUMBER:	214200040
ADMINISTRATOR:	CHIOVAROU, MAURA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 378-6403
CITY:	CORTE MADERA	STATE: CA	ZIP CODE:	94925
CAPACITY:	14	CENSUS: 9	DATE:	07/07/2021
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Maura Chiovarou		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Day care child sustained bruises while in care.

INVESTIGATION FINDINGS:

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*** This report was prepared in CCLD Regional Office, San Bruno on 7/7/21. This inspection was conducted via phone call. Licensee was informed that a copy of today’s report will be emailed to her. Confirm receipt is required. ***

Licensing Program Analyst (LPA), Farhan Bashir-Tariq called and spoke to Licensee, Maura Chiovarou to deliver the findings of this complaint investigation on 7/7/21. Purpose of inspection was explained. During the course of investigation, interviews were conducted with Licensee. As part of this investigation, parents’ letters, staff statements and facility roster were also collected. It was established after completing investigation that lack of supervision occurred in home, which resulted in child sustaining bruises on his body.

Based on records review and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.”).

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021

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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Control Number 05-CC-20210409152828

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CHIOVAROU, MAURA	FACILITY NUMBER: 214200040
	VISIT DATE: 07/07/2021

NARRATIVE

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> Type A deficiency was cited today under Title 22 Division 12 of the California Code of Regulations.

Reports citing Type A violations are to be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file. This report and rights to comment and appeal were discussed with Licensee. This report must be available in the facility for public review. Licensee was advised for any additional questions to call office, M-F, 8AM-5PM at 650-266-8800 . For Rules and Regulations, visit the Website: www.cdss.ca.gov

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021

LIC9099 (FAS) - (06/04)

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Control Number 05-CC-20210409152828

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CHIOVAROU, MAURA	FACILITY NUMBER: 214200040
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/07/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/08/2021 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	101229 (a)(1)...Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.	1 2 3 4 5 6 7	Licensee took immediate action to ensure that no child is left unattended for any amount of time. Licensee shall renew supervision and personal rights training with her staff. Staff must sign the declaration to confirm receipt of training.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by record reviews and interviews. Licensee failed to provide adequate level of care and supervision, which resulted in child sustaining bruises on his body. This poses an immediate health and safety risk to children in care.	8 9 10 11 12 13 14	A copy of written confirmation shall be emailed to LPA by 7/12/21.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021

LIC9099 (FAS) - (06/04)

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