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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304313187
Report Date: 06/07/2023
Date Signed: 06/07/2023 03:58:01 PM

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
03/27/2023 and conducted by Evaluator Nguyen K Tran
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20230327100614
FACILITY NAME:GHANBARZADEH, DONYAFACILITY NUMBER:
304313187
ADMINISTRATOR:GHANBARZADEH, DONYAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 963-2323
CITY:IRVINESTATE: CAZIP CODE:
92604
CAPACITY:14CENSUS: 9DATE:
06/07/2023
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Donya Ghanbarzadeh, LicenseeTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Licensee hit a daycare child while in care.
Licensee demonstrated inappropriate form of punishment.
Licensee did not provide adequate supervision to a daycare child.
INVESTIGATION FINDINGS:
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On 06/07/2023, Licensing Program Analyst (LPA) Tran conducted an in person inspection to deliver the finding regarding the above complaint allegations. Observed at the time of visit was 9 children with 2 staff members. LPA Tran met with Licensee Donya Ghanbarzadeh and informed Licensee the purpose of the visit.

A review of the Facility Personnel Report Summary on 06/07/2023 indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 03/27/2023, the office received a complaint alleging, Licensee hit a daycare child while in care, Licensee demonstrated inappropriate form of punishment, Licensee did not provide adequate supervision to a daycare child.

(Continue next page)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 795-0859
LICENSING EVALUATOR NAME: Nguyen K TranTELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
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 6
Control Number 06-CC-20230327100614
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: GHANBARZADEH, DONYA
FACILITY NUMBER: 304313187
VISIT DATE: 06/07/2023
NARRATIVE
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(Page 2 of Report)

During the investigation, LPA interviewed 2 staff and one child on 04/04/23 during initial investigation. On 05/18/23 and 05/22/23, LPA attempted to interview 2 former staff who were present on the date of the incident 03/16/2023. One out of two former staff responded and was interviewed on 05/22/23. LPA contacted 6 parents on 05/30/2023 for an interview, 3 out of 6 contacted parents were interviewed. LPA also attempted to interview subject child on 06/07/2023, however subject child did not qualify for the interview.

During a confidential interview, it was reported that Licensee hit child, put hand over child's mouth when child was crying. It was also reported that Licensee did not provide adequate supervision for child since Licensee did not have reasonable explanations for child's injuries.

During the interviews, two interviewed staff on 04/04/2023 and one interviewed staff on 05/22/2023 denied that they ever witnessed any adult in the home hit any child in care and denied that they ever witnessed Licensee placed hand over any child's mouth when child cried. All interviewed staff confirmed that they would be communicating with each other to ensure supervision is provided adequately for the children in care should they need a break, and keep the children engaged in activities for supervision. All interviewed staff described that the staff would talk to child to help child calm down, redirect child if child does not comply and have child sit on thinking chair for 1-2 minutes if child continue to not following directions and inform parents if needed. Only one child in the day care qualified for the interview and interviewed child denied witnessing any adult hit any child in care. Interviewed child also stated that subject child fell on the floor on the date of the incident and was hurt and cried. Interviewed child denied that child ever witnessed any child was left alone while in care. Out of six parents were contacted for an interview, three parents responded and were interviewed. All interviewed parents provided no concern related to the above allegations.

Based on the information gathered from LPA’s interviews, there is insufficient evidence to corroborate the allegations Licensee hit a day care child while in care, Licensee demonstrated inappropriate form of punishment, Licensee did not provide adequate supervision to a day care child. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged Licensee hit a day care child while in care, Licensee demonstrated inappropriate form of punishment, Licensee did not provide adequate supervision to a day care child, did or did not occur, therefore the listed allegation is UNSUBSTANTIATED. (Continue next page)
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 795-0859
LICENSING EVALUATOR NAME: Nguyen K TranTELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 06-CC-20230327100614
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: GHANBARZADEH, DONYA
FACILITY NUMBER: 304313187
VISIT DATE: 06/07/2023
NARRATIVE
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(Page 3 of Report)

Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Licensee Donya Ghanbarzadeh.

(End of Report)

SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 795-0859
LICENSING EVALUATOR NAME: Nguyen K TranTELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
03/27/2023 and conducted by Evaluator Nguyen K Tran
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20230327100614

FACILITY NAME:GHANBARZADEH, DONYAFACILITY NUMBER:
304313187
ADMINISTRATOR:GHANBARZADEH, DONYAFACILITY TYPE:
810
ADDRESS:4461 ROBINWOOD CIRTELEPHONE:
(818) 963-2323
CITY:IRVINESTATE: CAZIP CODE:
92604
CAPACITY:14CENSUS: 9DATE:
06/07/2023
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Donya Ghanbarzadeh, LicenseeTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Licensee did not properly report an incident involving a daycare child.
INVESTIGATION FINDINGS:
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On 06/07/2023, Licensing Program Analyst (LPA) Tran conducted a in person inspection to deliver the finding regarding the above complaint allegations. Observed at the time of visit was 9 children with 2 staff members. LPA Tran met with Licensee Donya Ghanbarzadeh and informed Licensee the purpose of the visit.
A review of the Facility Personnel Report Summary on 06/07/2023 indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 03/27/2023, the office received a complaint alleging, Licensee did not properly report an incident involving a daycare child.

(Continue next page)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 795-0859
LICENSING EVALUATOR NAME: Nguyen K TranTELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 06-CC-20230327100614
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: GHANBARZADEH, DONYA
FACILITY NUMBER: 304313187
VISIT DATE: 06/07/2023
NARRATIVE
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(Page 2 of Report)

During the initial investigation on 04/04/2023, Licensee provided text messages, in which, Licensee responded to child's representative due to child's representative had concerns about child's injuries. However, Licensee failed to provide any evidence to prove that Licensee reported the injuries to the child's representative. Licensee confirmed that Licensee did not initiate the communication with child's representative regarding concerns of child's injury.

Based on information gathered from LPA's interview and record review, the preponderance of evidence standard has been met, therefore the above allegation Licensee did not properly report an incident involving a day care child is found to be SUBSTANTIATED. California Code of Regulations, Title 22 Division 12 Chapter 1, Section 102416.2 (f)(1) Reporting Requirements is being cited on the attached LIC9099D.

Appeal Rights and deficiency were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Licensee Donya Ghanbarzadeh.

(End of Report)


SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 795-0859
LICENSING EVALUATOR NAME: Nguyen K TranTELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 06-CC-20230327100614
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: GHANBARZADEH, DONYA
FACILITY NUMBER: 304313187
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/14/2023
Section Cited
CCR
102416.2(f)(1)
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102416.2 Reporting Requirements (f) As soon as possible...the licensee shall notify a child's parent or authorized representative... (1) Any injury suffered by a child in care...

This requirement is not met evidenced by:
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Licensee stated Licensee will submitted a statement of understanding of the reporting requirement and will ensure to report all required incidents to all involved parties, to LPA by due date.
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Based on information gathered from LPA's interview and record review, Licensee confirmed that Licensee did not initiate the communication with child's representative regarding concerns of a child's injury, which posed a potential risk to the health, safety, and personal rights of children in care.
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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: Rina LopezTELEPHONE: (714) 795-0859
LICENSING EVALUATOR NAME: Nguyen K TranTELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 6