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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414004999
Report Date: 02/05/2025
Date Signed: 02/05/2025 11:22:11 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/11/2024 and conducted by Evaluator Maria Olguin-Leon
COMPLAINT CONTROL NUMBER: 05-CC-20241211102537
FACILITY NAME:GHASEMZADEH, MOJGANFACILITY NUMBER:
414004999
ADMINISTRATOR:GHASEMZADEH, MOJGANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 545-1402
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY:12CENSUS: 3DATE:
02/05/2025
UNANNOUNCEDTIME BEGAN:
09:56 AM
MET WITH:Mojgan GhasemzadehTIME COMPLETED:
11:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee did not provide adequate supervision resulting in child being injured.
Licensee uses inappropriate restraint for an extended period of time.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On February 5, 2025 @ approx. 9:55 am, Licensing Program Analyst (LPA) Maria Olguin-Leon conducted an unannounced visit to close the complaint investigation into the above allegations and met with Licensee Mojgan Ghasemzadeh. Present during today’s visit was licensee, helper and 3 children (2 infant and 1 preschool age). LPA toured home for health and safety hazards.

During the course of the investigation, LPA inspected home, conducted interviews, conducted observations, and reviewed pertinent documentation provided. Based on evidence obtained, it was determined that the allegations, Licensee did not provide adequate supervision resulting in child being injured and Licensee uses inappropriate restraint for an extended period of time, is determined to be UNSUBSTANTIATED. Although the above allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Notice of Site Visit shall remain posted for 30 days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. This report is public and can be reviewed.

Exit interview was conducted and report was reviewed with Licensee, Mojgan Ghasemzadeh and Appeal rights were provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025
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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