376627064-2-10-2020-51-CC-MCUY-BLSR4U-20200214114205

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 376627064
Report Date: 02/10/2020
Date Signed: 02/10/2020 03:55:02 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/20/2019 and conducted by Evaluator Selina Siao

PUBLIC

COMPLAINT CONTROL NUMBER: 51-CC-20191120145305

FACILITY NAME:	GHOLAMI, GHOLAM & HOSEINI, MARYAM FCC		FACILITY NUMBER:	376627064
ADMINISTRATOR:	MARYAM H,& GHOLAMI GHOLAM		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 792-8995
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92019
CAPACITY:	14	CENSUS: 11	DATE:	02/10/2020
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Maryam & Gholam Gholami and Zahra Gholami		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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9

Facility failed to keep the home free of pests

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Selina Siao conducted an unannounced inspection to investigate the above allegation. The initial inspections were conducted by LPA Siao on 11/25/2019 and 02/04/2020. Upon arrival there were 11 children in care including two infants, five preschool age children and four school age children including licensee's son. Throughout the course of investigation, several day care parents, several day care children, licensee, co-licensee and helpers were interviewed.
On 11/25/2019, LPA Siao observed several roach’s motel glue traps with dead roaches inside the kitchen. The home is free of rodents including roaches on 2/04/2020 as licensee Maryam stated that her husband treated the home outside and inside with pesticide during the Christmas holiday when the facility was closed. Based on LPA’s observations and interviews which were conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED, California Code of Regulations, 102423(a)(2) is being cited on the attached LIC 9099D.
Appeal Rights (1/16) were discussed and provided. Notice of Site Visit was posted during this visit and will remain posted for 30 days.
This report was translated to licensee Gholam Gholami during today's inspection by licensee's daughter/visitor Zahra Gholami. .

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina Siao	TELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2020

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 4

Control Number 51-CC-20191120145305

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: GHOLAMI, GHOLAM & HOSEINI, MARYAM FCC	FACILITY NUMBER: 376627064
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/10/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/10/2020 Section Cited CCR 102423(a)(2)	1 2 3 4 5 6 7	Personal Rights 102423(a)(2) 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: To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.	1 2 3 4 5 6 7	Licensee and Co-licensee stated that they have spray some pesticide during the holidays when the day care is closed outside and inside to ensure the home is free of pest. During the follow up inspections on
	8 9 10 11 12 13 14	This requirement is not met as evidence by: On 11/25/2019, LPA Siao observed several roach motel baits glue traps in the kitchen with dead roaches. This poses a potential health and safety risk to clients in care.	8 9 10 11 12 13 14	2/04/2020 and 2/10/2020 the home is free of pests including ants and roaches.
	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: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina Siao	TELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2020

LIC9099 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/20/2019 and conducted by Evaluator Selina Siao

PUBLIC

COMPLAINT CONTROL NUMBER: 51-CC-20191120145305

FACILITY NAME:	GHOLAMI, GHOLAM & HOSEINI, MARYAM FCC		FACILITY NUMBER:	376627064
ADMINISTRATOR:	MARYAM H,& GHOLAMI GHOLAM		FACILITY TYPE:	810
ADDRESS:	1382 IVORY COURT		TELEPHONE:	(619) 792-8995
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92019
CAPACITY:	14	CENSUS: 11	DATE:	02/10/2020
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Maryam & Gholam Gholami and Zahra Gholami		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

1
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5
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7
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9

Adults in the home hit child
Licensees failed to keep the home clean
The cats in the home h lice
Facility failed to feed children

INVESTIGATION FINDINGS:

1
2
3
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5
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7
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Licensing Program Analyst (LPA) Selina Siao conducted an unannounced inspection to investigate the above allegations. The initial inspections were conducted by LPA Siao on 11/25/2019 and 02/04/2020. Upon arrival there were 11 children in care including two infants, five preschool age children and four school age children including licensee's son.
Throughout the course of investigation, several day care parents, several day care children, licensee, co-licensee and helpers were interviewed. Licensee, co-licensee and helpers denied hitting ever hitting the day care children or their own children when children are in care. The children that were interviewed did not disclosed ever being hit or seeing children being hit. Licensees and helpers stated that they always feed the children and the children interviewed stated that they are never denied of food. LPA Siao observed the home to be clean during all three inspections. The parents that were interviewed did not have any concerns regarding the above allegations. The above allegations are deemed unsubstantiated which means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. See LIC9099C for cont.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina Siao	TELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 51-CC-20191120145305

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: GHOLAMI, GHOLAM & HOSEINI, MARYAM FCC	FACILITY NUMBER: 376627064
	VISIT DATE: 02/10/2020

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	Appeal Rights (1/16) were discussed and provided. Notice of Site Visit was posted during this visit and will remain posted for 30 days. This report was translated to licensee Gholam Gholami during today's inspection by licensee's daughter/visitor Zahra Gholami.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina Siao	TELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2020

LIC9099 (FAS) - (06/04)

Page: 4 of 4