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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304312946
Report Date: 08/03/2021
Date Signed: 08/03/2021 05:10:02 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/29/2021 and conducted by Evaluator Tina Nguyen
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20210729161618
FACILITY NAME:IBRAHIM, ALIAFACILITY NUMBER:
304312946
ADMINISTRATOR:IBRAHIM, ALIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 931-7469
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY:14CENSUS: 31DATE:
08/03/2021
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee Alia IbrahimTIME COMPLETED:
05:20 PM
ALLEGATION(S):
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Licensee is operating over capacity.
INVESTIGATION FINDINGS:
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On 08/03/2021 at 10:00 AM, Licensing Program Manager Thuy Ho and Licensing Program Analyst (LPA) Tina Nguyen conducted an unannounced complaint inspection regarding the above allegation. Upon arrival, LPM and LPA met with licensee Alia Ibrahim and discussed the purpose of the inspection.
On 07/30/2021, Licensing office received a complaint alleging licensee is operating over capacity.

During the tour of the facility, at 10:10 AM, LPM Ho and LPA Nguyen observed 16 preschool children and 1 infant with 2 staff members in the fitness room and 14 school age children with 2 staff members in daycare room. Licensee was operating over the licensed capacity as specified on license.

A review of the Facility Personnel Report Summary on this date 08/03/2021 at 10:10 AM indicated not all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
(continue on page 2)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Tina Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
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 6
Control Number 06-CC-20210729161618
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: IBRAHIM, ALIA
FACILITY NUMBER: 304312946
VISIT DATE: 08/03/2021
NARRATIVE
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Continue on page 1

America Garcia (staff #1, S1) and Sabrina Mendez (staff #2, S2) did not have fingerprint during today inspection. During the interviews, licensee and S1 confirmed that S1 has been working at the facility since July 19, 2021. Licensee and S2 confirmed that S2 has been working at the facility since July 26, 2021; 1000$ Civil penalty was being assessed during today inspection.

On 08/03/2021, at 10 AM, 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 this facility, all five staff member including the licensee did not wear face coverings while in the facility as required by the CA Dept. of Public Health Guidance on the Use of Face Coverings issued June 18,2020 and updated November 16, 2020 and an individual mask exception did not apply.

Based on the observation and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division & Chapter 3, 102370 Criminal Record Clearance (d)(1), 102416.5 Staffing Ratio and Capacity (f), 102423 Personal Rights (a)(2) are being cited on the attached LIC9099D.

This report cites a Type A violation and shall 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.

Exit interview was conducted. Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. The Notice of Site Visit was posted. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00.

End of Report.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Tina Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 06-CC-20210729161618
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: IBRAHIM, ALIA
FACILITY NUMBER: 304312946
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/03/2021
Section Cited
CCR
102370(d)(1)
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102370 Criminal Record Clearance (d) All individuals subject to a criminal record review pursuant...prior to working, residing, or volunteering in a licensed facility:(1) Obtain a California clearance ... by the Department. This requirement is not met as evidenced by: Based on observation and interviews, on 08/03/2021, at 10:10 AM
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Licensee stated facility will make sure complete fingerprint for all staff. Licensee stated that America Garcia and Sabrina Mendez will do fingerprint by 08/03/2021. Ms. Garcia and Ms. Mendez can not return to the facility until they receive finger print clearances. LPA provided LIC 9163 forms and live scan phone number to licensee.
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Assistant America Garcia has worked at the facility without criminal clearance since July 19,2021 and assistant Sabrina Mendez has worked at the facility without criminal clearance since July 26, 2021. The licensee failed to obtain a california clearance. This poses an immediate Safety risk to the children in care.
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 1000$ Civil penalty was being assessed.
Type A
08/03/2021
Section Cited
CCR
102416.5(f)
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102416.5 Staffing Ratio and Capacity (f) The total licensed capacity for a Large Family Child Care Home shall not exceed fourteen children.This requirement is not met as evidenced by:
Based on the observation and interviews, at 10:10 AM, LPM Ho and LPA Nguyen observed 16 preschool children
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During the inspection, Licensee called parents to come picking up the extra 17 children home. Licensee stated that she will send a written statement stated that she will operate her facility within the licensed capacity as specified on license.
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and 1 infant with 2 staff members in the fitness room and 14 school age children with 2 staff members in daycare room. This poses an immediate Health and Safety risk to the 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.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Tina Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 06-CC-20210729161618
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: IBRAHIM, ALIA
FACILITY NUMBER: 304312946
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/03/2021
Section Cited
CCR
102423(a)(2)
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102423 Personal Rights (a) Each child receiving services from a family childcare home shall have certain rights ... (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement is not met as evidenced by: Base on observation, 08/03/2021 at 10 AM, licensee did not ensure the personal rights of
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After LPM and LPA requested licensee and her staffs to wear mask, licensee and her staffs put on the masks as the request.
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persons in care to safe and healthful accommodations. In this facility, all staffs did not wear face coverings while in facility as required by the CA Dept.of Public Health Guidance on use of face coverings issued June18,2020 and updated Nov16,2020, individual mask exception did not apply.
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This is a potential risk to the health and safety of 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.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Tina Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 6