300612766-11-5-2020-06-CC-THOO-BVHUR4-20201119144807

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 300612766
Report Date: 11/04/2020
Date Signed: 11/05/2020 09:26:35 AM

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
06/19/2020 and conducted by Evaluator Stacy Torrence

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20200619101315

FACILITY NAME:	KHOOBAN, YAEL		FACILITY NUMBER:	300612766
ADMINISTRATOR:	KHOOBAN, YAEL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 529-9400
CITY:	BREA	STATE: CA	ZIP CODE:	92821
CAPACITY:	14	CENSUS: 4	DATE:	11/04/2020
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Yael, Khooban, Licensee		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

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Provider is not adequately addressing daycare child’s diapering needs
Provider is not providing adequate supervision resulting in a child being bit by another child

INVESTIGATION FINDINGS:

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Tele-Investigation due to Covid-19 State of Emergency
This is an amended version of the original report created on 11/04/2020

Licensing Program Analyst (LPA) Stacy Torrence conducted a tele-investigation via facetime, to deliver the finding regarding the above complaint allegations. During the tele-inspection, LPA Torrence virtually toured the facility with Yael Khooban, licensee. LPA Torrence observed 4 children, in the designated day care area.
During today’s investigation the facility was operating within its licensed capacity and within compliance of staffing ratios. A review of staff records on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2020

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 06-CC-20200619101315

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: KHOOBAN, YAEL	FACILITY NUMBER: 300612766
	VISIT DATE: 11/04/2020

NARRATIVE

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Allegation: Provider is not adequately addressing day care child’s diapering needs.
Reporting Party (RP) reported child has had multiple diaper rashes. During the course of the investigation, LPA interviewed licensee and one parent. Licensee stated diapers are changed at least every two hours, or whenever necessary. Parent had no issues or concerns regarding licensee changing child’s diaper.

Allegation: Provider is not providing adequate supervision resulting in a child being bit by another child.
Reporting Party (RP) reported child was bitten by other children. Licensee disclosed that she was aware one child did bite another child. Licensee stated she was present; however, she couldn’t get over there in time to stop it from happening. No disclosure by licensee of any other biting incidents. Parent stated was aware of child biting another child and is working with child.

No children were interviewed, due to being non-verbal.

Based on interviews conducted with licensee and parent, there is insufficient evidence to corroborate the allegations. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations of; provider is not adequately addressing day care child’s diapering needs and provider is not providing adequate supervision resulting in a child being bit by another child, did or did not occur; therefore, the allegations are unsubstantiated.

Exit interview was conducted. The report was reviewed and discussed. Appeal Rights were explained. A copy of the report along with Appeal Rights (LIC 9058 12/15) will be emailed to licensee with a Read Receipt to acknowledge report was received. If Read Receipt is not functional, licensee will respond to email stating “I have read and received the report, I acknowledge receipt.” LIC 9099 will also be mailed if those options are not available. The Notice of Site Visit was not posted due to tele-investigation COVID-19 State of Emergency.

End of Report

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2020

LIC9099 (FAS) - (06/04)

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