<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376624620
Report Date: 02/24/2022
Date Signed: 02/24/2022 09:41:30 AM


Document Has Been Signed on 02/24/2022 09:41 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108



FACILITY NAME:ASTANZAI, BENAFSHA FAMILY CHILD CAREFACILITY NUMBER:
376624620
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:0CENSUS: DATE:
02/24/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
09:06 AM
MET WITH:Benafsha AstanzaiTIME COMPLETED:
09:45 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Nancy Diaz and LPM Tashima Daniel met with Licensee Benafsha Astanzai to conduct a Case Management inspection. The purpose of today's inspection is to notify the Licensee that after a review of the investigation and findings that were delivered on 01/11/22, the Community Care Licensing department has determined that an enhanced civil penalty will be assessed for the Substantiated allegation of "Child sustained serious head injury". The complaint investigation determined that Child 1 in your direct care sustained a serious head injury resulting in a subdural hematoma as a result of physical abuse.

Therefore, an immediate civil penalty is warranted in accordance with the California Health and Safety Code Section: 1597.58(f)(1), for a violation that the department determines constitutes physical abuse or resulted in serious injury, as defined in Section 1596.8865, to a child.

You are hereby notified that an enhanced civil penalty of $1,000.00 is assessed for a violation that resulted in the
serious bodily injury of a client. You will receive an invoice from the Department to pay the civil penalty.

This report was discussed with the Licensee and a copy of this report was provided, along with a copy of the Appeal Rights.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:
DATE: 02/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/24/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1