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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434403322
Report Date: 10/08/2021
Date Signed: 10/08/2021 12:17:57 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/17/2021 and conducted by Evaluator Marilou Monico
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20210817142817
FACILITY NAME:AKBARI-FEO, MARIAFACILITY NUMBER:
434403322
ADMINISTRATOR:AKBARI-FEO-, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 371-7863
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY:14CENSUS: 7DATE:
10/08/2021
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Maria Akbari-FeoTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Uncleared adults in the home
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marilou Monico conducted a complaint inspection. LPA met with Licensee, Maria Akbari-Feo, and explained the purpose of today's visit. During the course of the investigation, LPA learned from interviews that licensee's adult son, Armand Akbari, was residing in the home from March 2020 to August 2021 without fingerprint clearance, therefore, the above allegation is SUBSTANTIATED, meaning the allegation is valid because the preponderance of the evidence standard has been met.

Type A deficiency is being cited on the attached LIC 9099D form.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS AS WELL AS THE TYPE A VIOLATION.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021
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 07-CC-20210817142817
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: AKBARI-FEO, MARIA
FACILITY NUMBER: 434403322
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/08/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
10/11/2021
Section Cited
CCR
102370(d)(1)
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Criminal Record Clearance - All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department.
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Licensee states she will submit a written plan by 10/11/21 detailing how to prevent this violation from occurring in the future.
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This requirement was not met as evidenced by: Licensee's adult son, Armand Akbari, was residing in the home from March 2020 thru August 2021 without fingerprint clearance. This poses an immediate risk to the health and safety of children in care.

Civil penalty of $500 was assessed.
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Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.
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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: Anthony Studebaker
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3