Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376627064
Report Date: 07/26/2018
Date Signed: 07/26/2018 03:46:30 PM


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/29/2018 and conducted by Evaluator Vicky Williamson
PUBLIC
COMPLAINT CONTROL NUMBER: 20-CC-20180529135732
FACILITY NAME:GHOLAMI, GHOLAM & HOSEINI, MARYAM FCCFACILITY NUMBER:
376627064
ADMINISTRATOR:MARYAM H,& GHOLAMI GHOLAMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 792-8995
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY:14CENSUS: 0DATE:
07/26/2018
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Maryam HoseiniTIME COMPLETED:
04:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Overcapacity commencing 4/11/18
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Vicky Williamson conducted an unannounced complaint inspection in regards to the above allegation. LPA met with Licensee, Maryam Hoseini to discuss allegation. Also present during the time of inspection were applicant's 2 minor sons and adult son Alireza Gholami who aided as a translator due to applicant's primary language being Farsi. There were no day care children present during today’s inspection. It was alleged that the facility is operating over capacity commencing 4/11/18. Interviews were conducted with licensee, co-licensee, outside agencies, witnesses, and day care parents. Documentation obtained from an outside agency provides proof that on April 11, 12, 18, 19, 25, and 26 between the hours of 5:30PM and 6:39 PM, licensee exceeded license capacity by providing care for a total of 12 children (ages 4-9 years of age, 1 of whom is under 24 months) at one time. Licensees current Family Child Care license specifies a capacity for 8 children. On the same above dates, between the hours of 6:40PM and 9:35PM, licensee exceeded capacity by providing care for a total of 11 children (ages 4-9 years of age, 1 of whom is under 24 months) at one time. Licensee and Co-Licensee acknowledged that on the above dates they exceeded current Family Child Care license and were over capacity. LPA, licensee and co-licensee discussed capacity/ratio for Family Child Care homes.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Vicky WilliamsonTELEPHONE: (619) 767-2214
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2018
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 20-CC-20180529135732
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: GHOLAMI, GHOLAM & HOSEINI, MARYAM FCC
FACILITY NUMBER: 376627064
VISIT DATE: 07/26/2018
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
26
27
28
29
30
31
32
Based on licensees admission, interviews with witnesses, day care parents, and documentation from outside agency obtained and reviewed the preponderance of evidence standard has been met that the facility operated over capacity, therefore the allegation is found to be SUBSTANTIATED.

California Code of Regulations, Title 22, Division 12, Chapter 3, is being cited on the attached LIC 9099D.

Licensee was provided appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. Notice of Site Visit (LIC 9213) was provided to be posted at the facility for 30 days. LPA observed form LIC 9213 posted.

AB633 requires upon receipt, Licensee shall post (observed by LPA) 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. An Acknowledgment of Receipt of Licensing Reports, Form LIC 9224 must be signed and placed in each child’s file.

An exit interview was conducted
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Vicky WilliamsonTELEPHONE: (619) 767-2214
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2018
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 20-CC-20180529135732
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: GHOLAMI, GHOLAM & HOSEINI, MARYAM FCC
FACILITY NUMBER: 376627064
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/26/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/03/2018
Section Cited
CCR
102416.5(a)
1
2
3
4
5
6
7
Staffing Ratio and Capacity. The capacity specified on the license shall be the maximum number of children for whom care can be provided. Requirement is not met as evidence by: Based on Licensees own admission and LPA's review of documentation obtained from an outside agency, it was determined that on April 11, 12, 18, 19, 25, and 26 between the hours of 5:30PM and 6:39 PM, licensee exceeded license capacity by providing care for a total of 12 children (ages 4-9 years of age, 1 of whom is under 24 months) at one time.
1
2
3
4
5
6
7
Licensee states that she and Co-licensee will read 102416.5 (a) and submit a sign copy of regulation to the Department no later than 8/3/18. Licensee states she will not allow the facility to become over capacity again.
8
9
10
11
12
13
14
On the same above dates, between the hours of 6:40PM and 9:35PM, licensees exceeded license by providing care for a total of 11 children (ages 4-9 years of age, 1 of whom is under 24 months) at one time. This poses an immediate risk to the health and safety of children in care.



8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Vicky WilliamsonTELEPHONE: (619) 767-2214
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2018
LIC9099 (FAS) - (06/04)
Page: 2 of 3