304314112-9-19-2024-06-CC-MMAE-DA4MSD-20241016095147

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304314112
Report Date: 09/18/2024
Date Signed: 09/19/2024 08:35:43 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 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
08/07/2024 and conducted by Evaluator Soo Jin Jung

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20240807153751

FACILITY NAME:	AKHAVAN, MAHJABIN		FACILITY NUMBER:	304314112
ADMINISTRATOR:	AKHAVAN, MAHJABIN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(949) 742-2581
CITY:	IRVINE	STATE: CA	ZIP CODE:	92620
CAPACITY:	14	CENSUS:	DATE:	09/18/2024
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Licensee Mahjabin Akhavan		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Child sustained unexplained injury while in care.
Uncleared adult(s) providing care to children.

INVESTIGATION FINDINGS:

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On 9/18/2024, at 10:40am, Licensing Program Analysts (LPA), Jung and Tran, conducted an unannounced visit to the facility to deliver findings for a complaint that was received at the Orange County Regional Child Care Licensing Office. LPAs met with Licensee Mahjabin Akhavan and Adult 1 (A1) and explained the reason for the visit. LPAs were led on a tour of the facility and observed a total of two (2) children and two (2) adults. At 12:30pm, two additional children arrived. During today’s inspection the facility was operating within its licensed capacity and within compliance of staffing ratios.

A review of the Facility Personnel Report Summary on this date indicates that one (1) adult, A1 who requires a caregiver background check has not received criminal record and child abuse index clearance or exemptions. A1 stated they have not received background check clearance and does not meet staffing qualifications according to Title 22 Regulations.
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Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Soo Jin Jung
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024

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 4

Control Number 06-CC-20240807153751

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: AKHAVAN, MAHJABIN	FACILITY NUMBER: 304314112
	VISIT DATE: 09/18/2024

NARRATIVE

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(Page 2)
On 8/7/2024, the Orange County Regional Child Care Licensing Office received a complaint with two allegations listed above: Reporting Party (RP) alleged that (1) Child sustained unexplained injury while in care (2) Uncleared adult(s) providing care to children.

On 8/8/2024, LPA Jung made an attempted visit. Resident Jessica informed LPA that licensee was not present, and daycare was closed for the day, although the licensee had not notified the Regional Office (RO) of facility’s temporary closure. When LPA requested entry, A1 refused and stated they were house-sitting and did not have licensee’s permission to allow entry to LPA. A1 stated they would submit LIC 9211 Request for Inactive Child Care License Status to Regional Office (RO), but RO did not receive the request. Facility was cited for violation of HSC 1596.99(c)(6) Refused entry to a facility or any part of a facility.

On 8/13/2024, LPA Jung made a second attempted visit. Adult 2 (A2) answered the door and refused entry to LPA. A2 stated that licensee was not present at the facility and that daycare was closed for the whole week. LPA reminded A2 to complete LIC 9211 if needed for extended temporary closure.

On 9/17/24, LPAs Jung and Tran made an unannounced visit to the facility. LPAs conducted surveillance and observed three families picking up their children from the facility. At 5:24pm, Female 1 (F1) picked up two children who are twins. At 5:43pm, Female 2 (F2) picked up one child. Around 5:50pm, Female 3 (F3) picked up one child. When interviewed, A1 stated they had been providing care to three (3) families for the past few weeks during the absence of the licensee.

On 9/18/24, LPAs Jung and Tran made an unannounced visit to the facility. LPAs met with Licensee Mahjabin Akhavan and A1 who were supervising four (4) children. Licensee stated they were not present at facility during LPA Jung’s visits in August, including the first week of August when the complaint incident occurred. Licensee and A1 stated that A1 and A2 have been residing at the facility and A1 assisted licensee with the daycare during licensee’s absence since the beginning of August. A1 stated they have been operating the daycare without knowledge of the licensee to provide care for a few families that requested care from the facility. Licensee and A1 confirmed that A1 and A2 have not received background clearances or exemptions. A1 provided a written statement which stated that Child 1 (C1) was present at the facility on 8/5/24 and sustained unexplained injuries on their face during nap time.
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SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Soo Jin Jung
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 06-CC-20240807153751

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: AKHAVAN, MAHJABIN	FACILITY NUMBER: 304314112
	VISIT DATE: 09/18/2024

NARRATIVE

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(Page 3)
The Orange County Regional Child Care Licensing Office has investigated the complaint alleging (1) Child sustained unexplained injury while in care and (2) Uncleared adult(s) providing care to children. Based on information gathered from LPAs’ interviews and record reviews, the preponderance of evidence standard has been met, therefore the allegations are found to be substantiated. California Health and Safety Code 1596.871(c)(1)(A) and California Code of Regulations, Title 22, Division 12 & Chapter 1, Section 102423(a)(2) Personal Rights are being cited; see LIC 9099D for deficiencies. Civil penalty was issued on this date for $500; see LIC

LPAs Jung and Tran informed licensee Mahjabin Akhavan that this report dated 9/18/2024 documents two Type A citations. Type A citations shall be posted for 30 consecutive days as there are immediate risks to the health, safety, or personal rights of children in care. LPAs informed the licensee to provide a copy of this licensing report dated 9/18/2024 that documents any Type A citations 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.

LPA Malek provided Farsi translation during the reading of the report.

End of Report.

SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Soo Jin Jung
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 06-CC-20240807153751

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: AKHAVAN, MAHJABIN	FACILITY NUMBER: 304314112
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/18/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/18/2024 Section Cited HSC 1596.871(c)(1)(A)	1 2 3 4 5 6 7	1596.871(c)(1)(A) Fingerprints and criminal record information of individuals in contact with child day care facility clients: a person...shall obtain...a criminal record clearance...prior to...presence in the facility. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee provided a declaration stating A1 and A2 will not be present at the facility during facility hours without background clearance. Licensee stated A1 and A2 will receive background clearance to continue living in the facility or move to another home. Licensee stated they will email their decision to LPA.
	8 9 10 11 12 13 14	Based on observation, interviews, and record reviews, the licensee did not ensure all adults in the facility were background checked prior to being in the facility which poses an immediate risk to the health, safety, and personal rights of the clients in care.	8 9 10 11 12 13 14
Type A 09/18/2024 Section Cited CCR 102423(a)(2)	1 2 3 4 5 6 7	102423(a)(2) Personal Rights: To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee stated they will provide more careful supervision to children in care. Licensee stated they will ensure supervision to children in care.
	8 9 10 11 12 13 14	Based on observation, interviews, and record reviews, the licensee did not ensure that Child 1 (C1) received safe and healthful accommodations, which poses an immediate risk to the health, safety, and personal rights of the clients in care.	8 9 10 11 12 13 14

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: Martha Malane
LICENSING EVALUATOR NAME: Soo Jin Jung
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024

LIC9099 (FAS) - (06/04)

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