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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416541
Report Date: 10/02/2025
Date Signed: 10/02/2025 02:15:02 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 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
08/11/2025 and conducted by Evaluator Darnella Barnes
COMPLAINT CONTROL NUMBER: 07-CC-20250811204038
FACILITY NAME:SAFFARI, MONIREHFACILITY NUMBER:
434416541
ADMINISTRATOR:MONIREH SAFFARIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 449-9434
CITY:SAN JOSESTATE: CAZIP CODE:
95118
CAPACITY:14CENSUS: 3DATE:
10/02/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Mansoureh RezagolpayeganiTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Daycare child sustained unexplained injury while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Darnella Barnes conducted an unannounced complaint visit to deliver investigation findings. The purpose of the visit was explained to Facility Representative Mansoureh Rezagolpayegani, who granted access to the facility.

LPA conducted a tour of the indoor and outdoor areas. Present at the time were the Assistant, staff member, and three children in care.

The complaint alleged that a daycare child (C3) sustained an unexplained injury while in care.

During the investigation, LPA reviewed facility records, conducted interviews, and made observations. Licensee and staff interviews indicated that children were under appropriate supervision throughout the day. No incident involving child (C3) was observed or reported. Both stated that (C3) exhibited no visible injuries or signs of distress at the time of pick-up. Both also noted that (C3) commonly moved by dragging herself forward using her arms.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Darnella Barnes
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025
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 2
Control Number 07-CC-20250811204038
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SAFFARI, MONIREH
FACILITY NUMBER: 434416541
VISIT DATE: 10/02/2025
NARRATIVE
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It was reported that approximately 30 minutes after leaving the facility, a bruise was discovered on (C3)’s arm. Staff and the Licensee present at the time of pick-up confirmed that no injuries were observed when the child was released to her parent. Interviews with other parents revealed no concerns about supervision.

During the visit, children were observed to be safe and adequately supervised. No safety or supervision concerns were noted.

Based on interviews, record reviews, and observations, it is concluded that although the 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.

No deficiencies were cited during today’s visit.

A Notice of Site Visit was issued and must remain posted for 30 days. Appeal rights were provided.

An exit interview was conducted, and the report was reviewed with Assistant Mansoureh Rezagolpayegani..

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Darnella Barnes
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2