<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013422559
Report Date: 03/15/2024
Date Signed: 05/28/2024 03:04:53 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/24/2024 and conducted by Evaluator Nyeesha Blount
COMPLAINT CONTROL NUMBER: 02-CC-20240124104430
FACILITY NAME:SHAFIEI, MEHDIFACILITY NUMBER:
013422559
ADMINISTRATOR:SHAFIEI, MEHDIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 926-7745
CITY:OAKLANDSTATE: CAZIP CODE:
94618
CAPACITY:14CENSUS: 7DATE:
03/15/2024
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:SHAFIEI, MEHDITIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights ~ Staff handled child in a rough manner.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
THIS IS AN AMENDED DOCUMENT FROM ORIGINAL DOCUMENT DATED 3/15/24.

On March 15, 2024 at 8:30 AM Licensing Program Analyst (LPA) Nyeesha Blount, conducted an Unannounced Complaint site inspection to deliver complaint findings. LPA met with Licensee Shafiei, Medhi, and (2) staff members who are background cleared. LPA advised Licensee of the nature of the inspection. Current Census today is 7 children which consists of (7) preschool children. LPA obtained a copy of the children's current roster, observations and staff interviews were conducted at the time of the inspection.

During the course of investigation LPA interviewed the licensee, staff, parents and children in care. RP advised her child was being pinched using thumb and forefinger on her arm when she is not listening RP stated her child mimic exactly what happened. Based on interviews conducted LPA is unable to determine if the alleged incident occurred. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. Therefore, the allegation is Unsubstantiated. Exit interview conducted. Appeal rights were discussed and given. This report must be kept available for public review for (3) years. Notice of site visit given.
Unsubstantiated
Estimated Days of Completion: 60
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Nyeesha Blount
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
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 1