197493782-3-10-2020-30-CC-VBAA-BMP2G9-20200313172246

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197493782
Report Date: 02/05/2020
Date Signed: 03/10/2020 11:18:37 AM

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
12/18/2019 and conducted by Evaluator Claudia Escobedo

PUBLIC

COMPLAINT CONTROL NUMBER: 30-CC-20191218132422

FACILITY NAME:	JAHANDIDEH FAMILY CHILD CARE		FACILITY NUMBER:	197493782
ADMINISTRATOR:	MASOUMEH PIR JAHANDIDEH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 219-2969
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91307
CAPACITY:	14	CENSUS: 13	DATE:	02/05/2020
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Licensee-Masoumeh Pir Jahandideh		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Allegation: Out of ratio

INVESTIGATION FINDINGS:

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On 02/05/2020 at 9:20 a.m., Licensing Program Analyst, (LPA) Escobedo conducted a second unannounced complaint investigation regarding the above allegation. LPA met with Licensee, Masoumeh Pir Jahandideh.

LPA reviewed children's records. At 10:15 a.m. LPA Escobedo informed Licensee that the facility was operating out of ratio, as there were 13 children in care, two infants and eleven preschool-aged children. Licensee proceeded to contact the parents of 2 children to be picked up. At 10:29 a.m., C2 and C4 were picked up from the Family Child Care Home.

Based on observation and record review, the allegation of facility operating out of ratio is substantiated. There was one deficiency cited during today's visit in accordance with the California Code of Regulations.
*This page has been amended* Continued on LIC 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Victor Bautista	TELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020

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-20191218132422

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: JAHANDIDEH FAMILY CHILD CARE	FACILITY NUMBER: 197493782
	VISIT DATE: 02/05/2020

NARRATIVE

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Title 22, Division 12, Chapter 1. See LIC 9099-D for additional information.

Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement of Receipt (LIC 9224 form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form during this visit.

An exit interview was conducted and Plans of Corrections were reviewed and developed with the Licensee. A copy of this report and appeal rights were discussed and left with the Licensee, Masoumeh Pir Jahandideh, whose signature on this form confirm receipt of these documents.

SUPERVISOR'S NAME: Victor Bautista	TELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2020

LIC9099 (FAS) - (06/04)

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Control Number 30-CC-20191218132422

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: JAHANDIDEH FAMILY CHILD CARE	FACILITY NUMBER: 197493782
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/05/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/06/2020 Section Cited CCR 102416.5(d)(2)	1 2 3 4 5 6 7	102416.5(d)(2)-Staffing Ratio and Capacity-...when there is an assistant provider...care...shall be ...twelve and up to fourteen children only if...At least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age.	1 2 3 4 5 6 7	Licensee will submit a written declaration to the department regarding her understanding of the number of children she is allowed in care by 02/21/2020.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based on observation and record review the Licensee did not ensure the number of children and ages met the ratio and capacity of her license, which poses an immediate Health, Safety or Personal Rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Victor Bautista	TELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2020

LIC9099 (FAS) - (06/04)

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