197406880-5-21-2021-30-CC-MRUZ-C3LNEK-20210602102405

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197406880
Report Date: 05/21/2021
Date Signed: 05/21/2021 02:39:04 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/05/2021 and conducted by Evaluator Laticia S Thompson

COMPLAINT CONTROL NUMBER: 30-CC-20210305101021

FACILITY NAME:	ZOLFAGHARI FAMILY CHILD CARE		FACILITY NUMBER:	197406880
ADMINISTRATOR:	ZOLFAGHARI MARYAM		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 341-6830
CITY:	CHATSWORTH	STATE: CA	ZIP CODE:	91311
CAPACITY:	14	CENSUS: 3	DATE:	05/21/2021
		UNANNOUNCED	TIME BEGAN:	11:19 AM
MET WITH:	Maryam Zolfaghari		TIME COMPLETED:	01:07 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Personal Rights- Adult interacted in an inappropriate manner with a day-care children

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 05/21/2021 Licensing Program Analyst (LPA) Laticia Thompson conducted an unannounced visit to Zolfaghari Family Child Care. LPA met with Maryam Zolfaghari (licensee). LPA advised Maryam Zolfaghari the reason for the visit today is to deliver the findings of the complaint received on 03/05/2021 regarding the allegations referenced above. LPA observed 3 children and 3 adults.

During the investigation of Allegation 1 revealed, there is not sufficient evidence to support nor deny that the allegation occurred. LPA interviewed children, parents and staff. LPA was unable to confirm that that an adult interacted in an inappropriate manner with a day-care children.

continued (9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Laticia S Thompson	TELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2021

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 30-CC-20210305101021

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ZOLFAGHARI FAMILY CHILD CARE	FACILITY NUMBER: 197406880
	VISIT DATE: 05/21/2021

NARRATIVE

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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 with Licensee, Maryam Zolfaghari, in which a copy of this report, a Notice of Site Visit (LIC 9213) and Appeal rights will be emailed to Licensee today. LPA explained to licensee to reply to the email as acknowledgment of receipt.

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Laticia S Thompson	TELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2021

LIC9099 (FAS) - (06/04)

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