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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343625436
Report Date: 01/24/2024
Date Signed: 01/24/2024 10:41:54 AM

Substantiated


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
01/19/2024 and conducted by Evaluator Michelle Perez
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20240119144137
FACILITY NAME:KOHZAD, MAHNAZFACILITY NUMBER:
343625436
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
01/24/2024
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Mahnaz KohzadTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Ratio: Licensee is operating over capacity
INVESTIGATION FINDINGS:
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On 1/24/2024, Licensing Program Analyst (LPA) Michelle Perez, arrived at the facility to open a complaint regarding ratio. Upon arrival, LPA observed five (5) children in care with the licensee, spouse and assistant.

The complaint alleged that the facility was operating over ratio during the weeks of December 20, 2023 through January 19, 2024. Attendance sheets were also provided by the complainant which show the amount of children each day at the facility, which documented the facility as over ratio. LPA spoke to the licensee and spouse during the visit, to discuss the ratios, as the licensee was in the process of increasing their capacity to a large family childcare. Licensee and spouse admitted, that during the holiday breaks, they accepted children who were on school break, which put them over their capacity of a small family childcare (which only allows no more than 8 children). Licensee explained that those children had already left care when school resumed.

Cont on 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024
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 3
Control Number 03-CC-20240119144137
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: KOHZAD, MAHNAZ
FACILITY NUMBER: 343625436
VISIT DATE: 01/24/2024
NARRATIVE
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Based on LPA's observations and interviews, which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED. Licensee will be assessed a citation A.

Licensee will have currently enrolled families sign the LIC 9224 "Acknowledgment of receipt of licensing reports," as well as all new/incoming families, for a year from this date of January 24, 2024. The LIC 9224 must be placed in each child's file. Failure to do so, will result in a subsequent citation. This report must be available for all families to review.

An exit interview was conducted and a notice of site visit was provided, which must be posted for 30-days.

Deficiency is recorded on 809-D
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 03-CC-20240119144137
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: KOHZAD, MAHNAZ
FACILITY NUMBER: 343625436
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/25/2024
Section Cited
CCR
102516.5(B)(3)
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For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following:
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Licensee understands that they were over ratio for their capacity, and no longer has the same children enrolled. Licensee will provide a letter to LPA confirming they understand Title 22 ratios for small and large family capacities.
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More than six and up to eight children, without an additional adult attendant, only if the criteria in Section 1597.44 of the Health and Safety Code are met.
This was not evidenced by, attendance sheets provided to licensing, showing over capacity ratios for a small family childcare.
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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: Keven Peters
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3