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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434412346
Report Date: 10/20/2022
Date Signed: 10/20/2022 01:00:38 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
10/13/2022 and conducted by Evaluator Janette Cruz
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20221013152011
FACILITY NAME:NEYNAVAEI, PERSHENGFACILITY NUMBER:
434412346
ADMINISTRATOR:NEYNAVAEI, PERSHENGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 431-9796
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY:14CENSUS: 4DATE:
10/20/2022
UNANNOUNCEDTIME BEGAN:
08:24 AM
MET WITH:Persheng, NeynavaeiTIME COMPLETED:
01:10 PM
ALLEGATION(S):
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Day care child was inappropriately disciplined.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Janette Cruz met with Persheng Neynavaei, Licensee, for an unannounced complaint investigation. LPA discussed the complaint allegation with Licensee and obtained a current Child Care Facility Roster. LPA observed, four children (4 infants) and Licensee's adult assistant Fariba Azad present during this inspection. LPA reviewed eight children's files, three staff files, and staff interviews were conducted.

Based on staff interview, both Licensee and Fariba admitted that on 10/07/22, Child (C1) was put on a restraint by being placed in a booster chair with tray, away from other children, while crying for 5 minutes. Therefore the above allegation is SUBSTANTIATED, meaning the allegation is valid because the preponderance of the evidence standard has been met.

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.



Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
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-20221013152011
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: NEYNAVAEI, PERSHENG
FACILITY NUMBER: 434412346
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/21/2022
Section Cited
WD
102423(a)(4)
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102423 Personal Rights
(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following:
(4) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning.
This requirement was not met as evidenced by:
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Licensee needs to submit a written plan of correction (POC) to the Department in regard to personal rights of children by POC due date. The POC must include in-service training to staff regarding personal rights, The POC must also provide steps to prevent personal rights violation from occurring again in the future.
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Based on observation, interviews and record reviews, Licensee did not comply with the section cited above. On 10/07/22, a child (C1) was put on a restraint by being placed in a booster chair with tray, away from other children, while crying for 5 minutes. This posed an immediate threat to the health and safety of the children
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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: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2