334845544-2-10-2021-10-CC-DPAR-BYE3Q9-20210219172647

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 334845544
Report Date: 02/10/2021
Date Signed: 02/10/2021 01:28:22 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/07/2020 and conducted by Evaluator Sean R Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 10-CC-20201007082454

FACILITY NAME:	GHOLIPOOR FAMILY CHILD CARE		FACILITY NUMBER:	334845544
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS:	DATE:	02/10/2021
		UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	MEHRNAZ GHOLIPOOR		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility is not free of insects.
Day Care child sustained insect bites while in care.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Sean Williams made an unannounced call to GHOLIPOOR FAMILY CHILD CARE for the purpose of concluding a complaint investigation via telephone regarding the above allegation(s). LPA spoke with Licensee, Mehrnaz Gholipoor. It was alleged that the facility was infested with insects that were biting children in the facilities care. During the course of the investigation, it was learned that the facility did have an insect problem.

Per Licensee, there was a problem with mosquitos at the beginning of 10/01/20. Licensee stated that she and other children were being bitten by mosquitos in her home. Licensee addressed the problem by hiring a pest control company to come to her home and treat for mosquitos two days after noticing the problem. Licensee provided proof of pest control service dated 10/03/20 and has reported that there are no further issues with any pest at this time.

CONTINUED ON NEXT PAGE

Substantiated

Estimated Days of Completion: 30

SUPERVISOR'S NAME: Dawn Parker	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Sean R Williams	TELEPHONE: (951) 204-2046
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2021

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 3

Control Number 10-CC-20201007082454

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: GHOLIPOOR FAMILY CHILD CARE	FACILITY NUMBER: 334845544
	VISIT DATE: 02/10/2021

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

Based on the information gathered the above allegation is deemed SUBSTANTIATED at this time on this date. Although the Licensee took the necessary actions to address the pest problem, the children in care were still affected by being bitten by mosquitos while in the Licensee's care. This is not considered healthful and comfortable conditions.

(A Type (B) Deficiency was issued in this case. (See LIC9099D). The violation is Personal Rights 102423(a)(2)

Closing phone interview was conducted and a copy of this report will be provided via email for the Licensee's signature. The Licensee will return the signed copy of this report via email.

Due to the COVID-19 State of Emergency, this report was completed via Tele-Inspections Report Delivery Instructions.

SUPERVISOR'S NAME: Dawn Parker	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Sean R Williams	TELEPHONE: (951) 204-2046
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 10-CC-20201007082454

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: GHOLIPOOR FAMILY CHILD CARE	FACILITY NUMBER: 334845544
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/10/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/22/2020 Section Cited CCR 102423(a)(2)	1 2 3 4 5 6 7	102423 Personal Rights (a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following:	1 2 3 4 5 6 7	Licensee corrected the problem by hiring a pest control company to treat the property for mosquitos. The pest problem was addressed on 10/03/20 with no further issues.
	8 9 10 11 12 13 14	(2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement was not met as evidence by the children being bitten by mosquitos while in the Licensees care. This did not provide healthful and comfortable accommodations for the children.	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: Dawn Parker	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Sean R Williams	TELEPHONE: (951) 204-2046
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 3