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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414004999
Report Date: 12/13/2024
Date Signed: 12/13/2024 04:35:44 PM

Substantiated


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:10CENSUS: 8DATE:
12/13/2024
UNANNOUNCEDTIME BEGAN:
02:43 PM
MET WITH:Mojgan GhasemzadehTIME COMPLETED:
04:55 PM
ALLEGATION(S):
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Licensee is operating over her ratio
INVESTIGATION FINDINGS:
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On December 13, 2024, at approx. 2:45pm, Licensing Program Analyst (LPA) Maria Olguin-Leon conducted an unannounced initial 10-day complaint inspection. LPA met with Licensee Mojgan Ghasemzadeh. LPA explained the purpose of the inspection. Present during today’s visit was licensee, helper, and 8 children (5 infants and 3 preschoolers).

LPA and licensee inspected for Health and Safety Hazards. LPA conducted observations and interviewed licensee and helper. LPA obtained a children’s roster and confirmed children’s birthdates.

During today’s inspection LPA reviewed and gathered information and determined the allegation, Licensee is operating over her ratio, to be SUBSTANTIATED.

Based on interview with Licensee, records reviewed, and observations, the preponderance of evidence standard has been met, therefore the above allegation(s) is found SUBSTANTIATED. California Code of Regulations are being cited on the attached LIC 9099D.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 05-CC-20241211102537
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: GHASEMZADEH, MOJGAN
FACILITY NUMBER: 414004999
VISIT DATE: 12/13/2024
NARRATIVE
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A civil penalty is being assessed due to a repeat violation, licensee had been previously cited for over capacity during annual inspection on November 14, 2024.

LPA Maria Olguin-Leon informed licensee Mojgan Ghasemzadeh that this report dated December 13, 2024, document(s) one Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Maria Olguin-Leon informed the licensee Mojgan Ghasemzadeh to provide a copy of this licensing report dated December 13, 2024, that documents any Type A citation(s) 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.

This report and appeal rights were provided and reviewed with the licensee. Mojgan Ghasemzadeh.

Notice of Site Visit shall remain posted for 30 days.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2024
LIC9099 (FAS) - (06/04)
Page: 1 of 1
Control Number 05-CC-20241211102537
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: GHASEMZADEH, MOJGAN
FACILITY NUMBER: 414004999
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/16/2024
Section Cited
CCR
102416.5(a)
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102416.5 Staffing Ratio and Capacity (a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.

This requirement is not met as evidenced by:
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LPA discussed capacity limits with licensee and provided licensee with capacity limits document. Per Licensee, today is the last day for one of the infants. Licensee understands no more than 4 infants and 8 older children over the age of 2 can be cared for under the limitations of license.
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Based on record review, interview and observations, conducted during today’s inspection. LPA confirmed licensee is operating over capacity, with 5 infants and 3 preschool age children in care, which poses an immediate health, safety, or personal rights risk to 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: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3