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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197415246
Report Date: 07/05/2023
Date Signed: 07/05/2023 02:40:18 PM

Unsubstantiated


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
04/19/2023 and conducted by Evaluator Judy Laureano
COMPLAINT CONTROL NUMBER: 58-CC-20230419091957
FACILITY NAME:MATAL-BANOS FAMILY CHILD CAREFACILITY NUMBER:
197415246
ADMINISTRATOR:MATAL-BANOS, ANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 919-4771
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY:14CENSUS: 7DATE:
07/05/2023
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Ana Matal BanosTIME COMPLETED:
01:35 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Neglect/Lack of Supervision: Child sustained injuries in care due to lack of supervision
Personal Rights: Licensee did not treat child with dignity.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 7/5/2023 Licensing Program Analyst (LPA) Judy Laureano conducted an announced complaint investigation regarding the above mentioned allegation. LPA met with Licensee Ana Matal Banos. LPA observed 7 children and one adult and licensee getting ready for nap time.

On 4/26/2023 Licensing Program Analyst (LPA) Judy Laureano conducted an unannounced complaint investigation regarding the above allegation. LPA met with the Licensee Ana Matal Banos. LPA observed 8 children and Licensee and Assistant providing care and supervision.

See page 2
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023
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 58-CC-20230419091957
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: MATAL-BANOS FAMILY CHILD CARE
FACILITY NUMBER: 197415246
VISIT DATE: 07/05/2023
NARRATIVE
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Page 2
LPA requested and reviewed the following: children's roster and children’s file. LPA interview licensee and assistant.

On 7/3/2023 Parent interviews were completed (P1, P3, P4, P5 and P6). On 7/5/2023 all interviews of relevant parties were completed. No information was disclosed that child's personal rights were violated or that child sustained injuries in care due to lack of supervision, therefore the allegations are UNSUBSTANTIATED, meaning although the allegations may have happened or are valid, the preponderance of the evidence standard has not been met.

Exit interview was conducted and a copy of the report was provided with a Notice of Site Visit.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2