<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 313622189
Report Date: 05/02/2024
Date Signed: 05/02/2024 04:02:24 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/03/2024 and conducted by Evaluator Dao Vang
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20240403130637
FACILITY NAME:BILGI, AYSEFACILITY NUMBER:
313622189
ADMINISTRATOR:BILGI, AYSE & BILGI, AVNIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(401) 612-4677
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:14CENSUS: 7DATE:
05/02/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Bilgi, AyseTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Parent was not provided LIC995A FCCH-Notification of Parents Rights.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 5/2/2024 at 1:00p.m., LPA Pa Dao Vang met with Licensee Ayse Bilgi for the purpose of an unannounced complaint inspection regarding the above allegation of the parent was not provided a copy of the LIC995A. LPA observed the census of 7 children in care supervised by 2 staff.

During the course of the investigation LPAs conducted interviews, made observations, and collected documentation. Based on 2 separate inspection days, LPA verified their background clearances through Guardian. LPA also reviewed 9 children’s files with the required LIC995A form. Through parent interviews, they don’t have any concerns about the form being provided. Licensee stated this form is provided along with other required documents at the intake prior to starting at the facility.

Continue report on LIC9909-C...

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
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 03-CC-20240403130637
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: BILGI, AYSE
FACILITY NUMBER: 313622189
VISIT DATE: 05/02/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Based on LPA interviews the preponderance of evidence standard has not been met; therefore, the above allegation is unsubstantiated. There are no Title 22 deficiency being cited for this allegation. An exit interview was conducted with Licensee Ayse Bilgi, a notice of site visit and appeal rights are provided. The Notice of Site Visit posted for 30 consecutive days for parents to view. Failure to comply with posting requirements can result in a $100 penalty.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2