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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343623051
Report Date: 08/18/2023
Date Signed: 08/18/2023 12:28:42 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/23/2023 and conducted by Evaluator Jennifer Velasco
COMPLAINT CONTROL NUMBER: 03-CC-20230523144546
FACILITY NAME:KIDS PARK-FOLSOM(PS)FACILITY NUMBER:
343623051
ADMINISTRATOR:AMIRI, AZADEHFACILITY TYPE:
850
ADDRESS:1111 RILEY STREETTELEPHONE:
(916) 293-8786
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:60CENSUS: 25DATE:
08/18/2023
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Ladan Shojaei KavanTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Child had unexplained injury while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst Jennifer Velasco (LPA) conducted unannounced subsequent complaint investigation inspection and met with Administrator Ladan Shojaei Kavan (M1). LPA toured the facility, including all activity and classroom spaces, restrooms, food service and play areas. Census included 25 children in the care of three classroom staff. M1 was reminded never to exceed the conditions, limitations, and capacity specified on the license. Facility hours of operation are Monday through Friday 7:30 AM - 8:00 PM, Saturday 9:00 AM - 10:00 PM, and Sunday 11:00 AM - 6:00 PM.

It was alleged a child sustained unexplained injury in care. During the investigation, LPA conducted interviews, observed staff provide care to children, and obtained relevant documentation. Witness statements, observations, and documentation failed to corroborate the allegation. Although the alleged violations may have happened or are valid, the preponderance of evidence standard has not been met to fully prove or disprove that they did or did not occur, therefore, they are unsubstantiated.

An exit interview was conducted, and this report was reviewed with Administrator Ladan Shojaei Kavan. A notice of site visit provided. Notice of site visit shall remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023
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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