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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376628334
Report Date: 05/21/2021
Date Signed: 05/21/2021 11:26:37 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, 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
04/08/2021 and conducted by Evaluator Michael Morales-DeSilvestore
PUBLIC
COMPLAINT CONTROL NUMBER: 51-CC-20210408115231
FACILITY NAME:ATOUFIAN, SHIVA FAMILY CHILD CAREFACILITY NUMBER:
376628334
ADMINISTRATOR:SHIVA ATOUFIANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 432-9772
CITY:SAN DIEGOSTATE: CAZIP CODE:
92127
CAPACITY:14CENSUS: DATE:
05/21/2021
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:TIME COMPLETED:
11:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is operating over capacity
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 5/21/21 Licensing Progam Analyst Michael Morales-DeSilvestore made an unannounced complaint visit for the complaint received on 4/8/21 for the purpose of delivering findings on the above reference allegation.

Based on the information obtained during interviews, observations, and documentation reviewed it is determined that although the allegation may be true, there is not a preponderance of the evidence to prove that the alleged violation occurred. Appeal Rights (1/16) were discussed and provided. Signature at the bottom of this report confirms receipt. Notice of Site Visit was posted and will remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Michael Morales-DeSilvestore
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2021
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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