304311916-10-19-2023-06-CC-PMAA-CXJV22-20231113150226

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304311916
Report Date: 10/19/2023
Date Signed: 10/19/2023 09:33:03 AM

Unsubstantiated

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
10/02/2023 and conducted by Evaluator Cindy Nguyen

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20231002144911

FACILITY NAME:	NESHATFAR, SHAHNAZ		FACILITY NUMBER:	304311916
ADMINISTRATOR:	NESHATFAR, SHAHNAZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(949) 923-0494
CITY:	IRVINE	STATE: CA	ZIP CODE:	92614
CAPACITY:	14	CENSUS: 3	DATE:	10/19/2023
		UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Licensee, Shahnaz Neshatfar		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Child sustained unexplained injuries while in the licensee's care.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Cindy Nguyen conducted an unannounced complaint investigation. This is a continuation of the investigation initiated on 10/04/2023. Upon arrival LPA met with Licensee, Shahnaz Neshatfar, who accompanied LPA on a tour of the facility. Present during today’s inspection was licensee, licensee’s husband, and licensee’s daughter. LPA observed 1 infant and 2 preschool age children with licensee. A review of staff criminal records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearance or exemption and a child abuse index clearance.

On 10/02/2023 a complaint was filed with the Department alleging that a child sustained unexplained injuries while in the licensee’s care. During the investigation, LPA Nguyen conducted 2 physical plant inspections, interviewed 3 staff members, a parent, obtained the facility admission agreement and a copy of the children's roster.
Continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 743-5149
LICENSING EVALUATOR NAME: Cindy Nguyen	TELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

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 06-CC-20231002144911

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: NESHATFAR, SHAHNAZ	FACILITY NUMBER: 304311916
	VISIT DATE: 10/19/2023

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

Page 9099C

Complainant alleged that Child #1 (C1) sustained (multiple) unexplained injuries while in the licensee’s care. On 08/16/23, a child was picked up and found bruises all over the child’s arms. There were two different other occasions. C1 was found with scratches and a bump on the head.

During the staff interviews, all 3 interviewed staff disclosed that the children are never left alone, there is always someone engaging and supervising the children. All staff interviewed stated they have not witnessed any incident with any of the children in care.

LPA Nguyen attempted to interview the children in care, but none were able to be qualified to be interviewed.
LPA called 3 parents, LPA was only able to interview one parent on 10/10/23. Parent #1 (P1) interviewed made no disclosures. P1 stated that the facility staff communicates daily with parents about what went on with their child(ren). P1 did not express any concerns with the care given to the children, or any issue with any staff at the facility. LPA did not receive a return call from the other 2 parents.

Based on the information gathered from LPA's interviews with complainant, 3 staff members, one parent, and reviewing records of facility's admission agreement, there is insufficient evidence to corroborate the allegation of child sustained unexplained injuries while in the licensee’s care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted with Licensee, Shahnaz Neshatfar. Notice of Site Visit was posted during the visit. The licensee was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 743-5149
LICENSING EVALUATOR NAME: Cindy Nguyen	TELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2