197493499-6-8-2023-58-CC-LRIS-CSXUPR-20230619154554

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197493499
Report Date: 06/08/2023
Date Signed: 06/08/2023 12:50:42 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
03/23/2023 and conducted by Evaluator Suzette Ornelas

PUBLIC

COMPLAINT CONTROL NUMBER: 58-CC-20230323153125

FACILITY NAME:	KUBI FAMILY CHILD CARE		FACILITY NUMBER:	197493499
ADMINISTRATOR:	KUBI, LIRAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 625-4840
CITY:	SHERMAN OAKS	STATE: CA	ZIP CODE:	91403
CAPACITY:	14	CENSUS: 12	DATE:	06/08/2023
		UNANNOUNCED	TIME BEGAN:	08:07 AM
MET WITH:	Licensee- Liran Kubi		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

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Allegation 1 - Provider is operating over capacity
Allegation 2 - Provider is operating out of ratio

INVESTIGATION FINDINGS:

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On 6/8/2023, Licensing Program Analyst (LPA) Suzette Ornelas conducted an unannounced visit
for the purpose of delivering the findings for the above-mentioned allegations. LPA Ornelas met with Licensee, KUBI, LIRAN and her husband Zack Kubi. LPA toured the facility and observed 12 children in care being supervised by 3 staff.

During the course of the investigation, LPA Ornelas made observations, conducted parent and staff interviews, obtained children’s roster, conducted children’s file reviews in regard to the above allegations.

On 3/27/2023, LPA Ornelas conducted an unannounced visit at the Facility. LPA made observations and obtained children’s roster.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023

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-20230323153125

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: KUBI FAMILY CHILD CARE	FACILITY NUMBER: 197493499
	VISIT DATE: 06/08/2023

NARRATIVE

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LPA Ornelas reviewed evidence provided and conducted parent interviews. Parents are reporting that they have no concerns regarding the care and supervision that their children are receiving at the Family Child Care (FCC). Parents are reporting that they are aware of the maximum capacity being 12, Parents stated that they know the parents whose children are enrolled and when it comes to events they take enough goodies for 12 children and extras for the 3 teachers.

Based on the evidence obtained over the course of the investigation, LPA Ornelas was unable to corroborate
that the Allegations: 1) Provider is operating over capacity; 2) Provider is operating out of ratio. Therefore, the allegations are determined Unsubstantiated. A finding that the complaint is unsubstantiated means
that although the allegation may have happened or is valid, there is not a preponderance of the evidence to
prove that the allegation occurred.

An exit interview was conducted, and a copy of this report, appeal rights along with the Notice of Site Visit were provided to with Licensee, KUBI, LIRAN.

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023

LIC9099 (FAS) - (06/04)

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