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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304313187
Report Date: 11/05/2024
Date Signed: 11/05/2024 04:19:15 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 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
09/23/2024 and conducted by Evaluator Mahnaz Malek
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20240923104856
FACILITY NAME:GHANBARZADEH, DONYAFACILITY NUMBER:
304313187
ADMINISTRATOR:GHANBARZADEH, DONYAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 963-2323
CITY:IRVINESTATE: CAZIP CODE:
92604
CAPACITY:14CENSUS: 3DATE:
11/05/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:LicenseeTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Child sustained unexplained injuries in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted a follow up investigation regarding the above allegation. This is a follow up for the visit conducted on 9/25/2024. LPA met with licensee, Donya Ghanbarzadeh. There were 3 napping children present of whom two were under 24 months old.
A review of staff records on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.
On 9/23/2024, the Orange County Childcare Office received a complaint alleging “Child sustained unexplained injuries in care”. RP stated that on 9/12/24, Child # 1 (C1) had three small circular bruises and a small scratch on the right cheek due to falling down a slide. On 9/19/24, R/P was notified by Adult # 1 (A1) regarding redness around C1’s right eye after nap time. R/P noticed a small laceration on C1’s right eyelid along with redness and bruising around the entire eye when C1 was picked up. Later, R/P observed another circular bruise on C1’s lower back.
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Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
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 5
Control Number 06-CC-20240923104856
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: GHANBARZADEH, DONYA
FACILITY NUMBER: 304313187
VISIT DATE: 11/05/2024
NARRATIVE
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The investigation involved interviews with 5 people who worked with children, obtaining enforcement agencies’ reports such as police, child protective services, C1’s medical report regarding the injuries, pictures, videos, and contacting ten parents of whom 4 responded to assess allegation concerning lack of supervision.

Adult # 1 (A1) stated C1 fell when playing on the plastic slide on the grass area in the back yard on 9/12/2024. A1 stated A1 observed C1 hit the face on the grass causing minor bruise on the cheek. C1 was fine all day. A1 noticed small scratch on the right cheek. On 9/19/2024 C1 played indoor and outdoor. A1 stated A1 did not observe child fall or any injury occurred to C1. A1 noticed C1’s eye was a little bit red and pink when C1 woke up from nap. A1 stated A1 thought C1’s eye was infected. A1 stated C1 was rough housing with C2 before nap time. However, A1 stated A1 did not observe C1 was pushed by C2 when playing on the carpet.

Adult # 2 (A2) stated A2 was not present on the days the incidents happened to C1.

Adult # 3 (A3) stated A3 was not normally involved with children’s activities and did not observe any injuries on C1.

Assistant # 4 (A4) stated A4 plays with children on occasions. A4 stated on the day of the incident of 9/19/2024, A4 arrived at the facility around 12:15 pm and played with children before their nap time. There were 3 children present on that day. A4 stated A4 did not observe C1’s eye being injured. A4 left the facility and came back around 2:15 pm. A4 observed C1’s eye being red and kind of scratched after C1 woke up. A4 reported to the best of A4’s knowledge, C1 and C2 were playing on the carpet and C1 might have fallen and got rug burn. However, A4 did not witness it.

Adult # 5 (A5) stated A5 plays with children on occasions when A5 is available at the facility. A5 stated A5 was at the facility on the day of C1's incident on 9/19/2024. There were 3 children present. C1 seemed fine playing. A5 did not observed any injury on C1. A1 showed A5 the C1’s eye after nap time. A5 observed a little bit scratch looks like infection in the corner of the C1’s eye. A5 stated A5 observed one incident the week before that C1 was standing on the little plastic slide and fell and hit the face on the grass area in the
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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 06-CC-20240923104856
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: GHANBARZADEH, DONYA
FACILITY NUMBER: 304313187
VISIT DATE: 11/05/2024
NARRATIVE
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backyard. C1 seemed fine and playing for the rest of the day. Bruises on the face/cheek, and on the back appeared later when C1 got home. A5 did not acknowledge observing children fight with each other since A5 is not with children all the time.
Medical report revealed the diagnosis of a superficial left upper eyelid laceration not involving any important structures of left eye and left facial bruising. findings consistent with trauma to the left side of face, verifying old bruising of right cheek.
Of the ten parents contacted, four responded, expressing no concerns regarding the allegation. Children were too young to be interviewed.
Based on the interviews with 5 persons working with children, reviewing 2 enforcement agencies’ reports such as reports from police, child protective services, medical report, pictures, videos, and contacting ten parents of whom 4 responded, it was determined the preponderance of evidence standard has been met, the allegation of “child sustained unexplained injuries in care”, is found to be SUBSTANTIATED. Please refer to 9099D next page for the details of citation issued. California Title 22 Regulations Section 102417(a) is cited on 9099D next page. During the course of investigation, LPA found out that licensee did not report to the Department the unusual incident such as the presence of the law enforcement at the family childcare home on 9/20/2024. This was cited under type B citation section 102416.2 (a)(3)(C) reporting requirement.
The licensee, Donya Ghanbarzadeh was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. Notice of Site Visit must be posted on or adjacent to the door. Failure to post will result in Civil Penalties of $100.00. LPA Malek informed the licensee, Donya Ghanbarzadeh that this report dated 11/5/2024 documents type A citation shall be posted for 30 consecutive days as there is immediate risks to the health, safety, or personal rights of children in care. Also, LPA Malek informed the licensee, Donya Ghanbarzadeh to provide a copy of this licensing report dated 11/5/2024 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. The licensee, Donya Ghanbarzadeh was provided with 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. The exit interview was conducted with licensee, Donya Ghanbarzadeh in her native language.
End of reports.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 06-CC-20240923104856
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: GHANBARZADEH, DONYA
FACILITY NUMBER: 304313187
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/06/2024
Section Cited
CCR
102417(a)
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Operation of a Family Childcare Home: The licensee shall be present in the home and shall ensure that children in care are supervised at all times. This requirement was not met as evidenced by a complaint report, 5 interviewees, reviewing enforcement agencies such as reports from police, child protective services,
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Licensee stated she would send to LPA a written statement signed by licensee and other assistants working with children at the family childcare home to make sure they supervise children at all times. The statement is due on 11/6/2024.
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medical report, pictures, videos, and contacting ten parents of whom 4 responded. C1 sustained unexplained injuries in care and no adults in care have knowledge of how the injury occurred. This poses an immediate risk to the health and safety of the 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.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 06-CC-20240923104856
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: GHANBARZADEH, DONYA
FACILITY NUMBER: 304313187
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/08/2024
Section Cited
CCR
102416.2(a)(3)(C)
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Reporting Requirement: The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm).(3) A report shall be made to the Department…following the occurrence during the operation of a family day care
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The licensee agreed to send a statement that she is aware of this section of Title 22 Regulations regarding reporting any unusual incident happening at her family child care home to the Department. The statement will be sent to LPA on or before 11/8/2024.
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home of any of the following events:(C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child."This requirement was not met as evidenced by the presence of law enforcement at the family childcare home on 9/20/2020. This is a potential risk to the health and safety 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.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5