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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197416878
Report Date: 07/14/2023
Date Signed: 07/14/2023 11:33:55 AM

Substantiated


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
07/10/2023 and conducted by Evaluator Loyce Phillips
PUBLIC
COMPLAINT CONTROL NUMBER: 58-CC-20230710094339
FACILITY NAME:MINWALLA FAMILY CHILD CAREFACILITY NUMBER:
197416878
ADMINISTRATOR:MINWALLA, SHAMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 801-8155
CITY:LOS ANGELESSTATE: CAZIP CODE:
90019
CAPACITY:14CENSUS: 4DATE:
07/14/2023
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:SHAMA MINWALLA, LICENSEETIME COMPLETED:
11:50 AM
ALLEGATION(S):
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Allegation: Reporting Requirements - Staff did not report incident to appropriate party.
INVESTIGATION FINDINGS:
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On 7/14/2023, Licensing Program Analyst (LPA) Loyce Phillips arrived at the facility for the purpose of conducting an initial complaint investigation. Upon arrival LPA met with Licensee, Shama Minwalla. LPA advised Licensee the purpose of the inspection was due to a complaint received by the El Segundo Child Care Regional Office (ESCCRO) on 7/10/2023. LPA observed 4 children in care with 1 staff.

During this inspection, interviewed staff and conducted a file review. Based on LPA record review of children files and Licensee statement, 2 of 4 parents did not receive LIC 9224. Therefore, the allegations of staff did not report incident to appropriate party is substantiated. Substantiated findings mean that the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies are being cited accordance to Title 22 of the California Code of Regulations and/or Health & Safety Codes. 9099-D.
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 results in a civil penalty of 100.00. Exit interview conducted, report and appeals rights were discussed and provided to Licensee.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Loyce Phillips
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023
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 58-CC-20230710094339
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: MINWALLA FAMILY CHILD CARE
FACILITY NUMBER: 197416878
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/17/2023
Section Cited
HSC
1596.8595(d)(1)(2)
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1596.8595(d)(1)(2) reports to be provided to parents or guardian of each child receiving services (d)(1) A licensed child day care facility shall provide to the parents or legal guardians of each child receiving services in the facility copies of any licensing do....(2)Upon enrollment of a new child in a facility, the licensee.......
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Licensee will provide parents with LIC 9224 Acknowledgement of receipt of licensing Reports by 7/17/2023. Licensee will provide a copy to LPA by POC date by email.
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This requirement is not met as evidenced by:
Based on LPA record review and Licensee statement 2 of 4 newly enrolled children files and Licensee statement of LIC 9224 has not been given.
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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.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Loyce Phillips
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023
LIC9099 (FAS) - (06/04)
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