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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197400845
Report Date: 11/03/2022
Date Signed: 11/09/2022 10:13:48 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/16/2022 and conducted by Evaluator Lillian J Casillas
PUBLIC
COMPLAINT CONTROL NUMBER: 58-CC-20220816114147
FACILITY NAME:KHOSHBAKHSH, JACKLIN F.D.C.FACILITY NUMBER:
197400845
ADMINISTRATOR:KHOSHBAKHSH, JACKLINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 932-6220
CITY:LOS ANGELESSTATE: CAZIP CODE:
90036
CAPACITY:12CENSUS: 12DATE:
11/03/2022
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Jacklin KhoshbakhshTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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9
License: Licensee is operating over capacity
INVESTIGATION FINDINGS:
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On 11/03/2022, Licensing Program Analyst (LPA) Lillian Casillas conducted an unannounced complaint visit for the purpose of delivering the findings for the allegation above. LPA met with Licensee, Jacklin Khoshbakhsh, and explained the purpose of the visit. LPA observed 12 children in care with 1 staff.

On 9/15/2022, LPA conducted an unannounced visit to initiate the complaint investigation. LPA interviewed the Licensee and Staff 1. LPA observed 9 children with 1 staff. LPA obtained copies of the LIC 9040 Child Care Roster, LIC 279B Current Children in Your Home, and calendar of Jewish holidays.

On 8/24/2022 and 8/25/2022, LPA attempted to conduct an unannounced 10-day complaint investigation due to the allegation above. No one answered the door and LPA did not observe any individuals present. On 8/25/2022, LPA walked over to 547 N. Highland Ave, Los Angeles, CA 90036 to inquire about the family child care home, and LPA spoke with Adult 1 (A1). A1 stated Licensee is on vacation.
[CONTINUE ON PAGE 2]
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 299-1025
LICENSING EVALUATOR NAME: Lillian J CasillasTELEPHONE: (310) 740-3039
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
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-20220816114147
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: KHOSHBAKHSH, JACKLIN F.D.C.
FACILITY NUMBER: 197400845
VISIT DATE: 11/03/2022
NARRATIVE
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PAGE 2

Based on observation and interviews with relevant parties, the allegation is deemed UNSUBSTANTIATED. 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 alleged violation occurred.

An exit interview was conducted and a copy of this report along with the Notice of Site Visit and Appeal Rights were provided to Licensee, Jacklin Khoshbakhsh.
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 299-1025
LICENSING EVALUATOR NAME: Lillian J CasillasTELEPHONE: (310) 740-3039
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2