304313893-7-10-2023-06-CC-PMAA-CTR2SJ-20230714173914

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304313893
Report Date: 07/07/2023
Date Signed: 07/10/2023 08:09:20 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/05/2023 and conducted by Evaluator Araceli Bootorabi

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20230505083039

FACILITY NAME:	MIRFATTAHI, SEYEDEH ZAHRA		FACILITY NUMBER:	304313893
ADMINISTRATOR:	MIRFATTAHI, SEYEDEH ZAHRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(949) 545-4057
CITY:	LAKE FOREST	STATE: CA	ZIP CODE:	92630
CAPACITY:	14	CENSUS:	DATE:	07/07/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	MIRFATTAHI, SEYEDEH ZAHRA		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Provider is administering unprescribed medication to day care children.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Census upon entry was as followed: 00 Infant / 04 Children 2+ / 02 Adults Working with children/ 02 Other adults
Licensing Program Analyst (LPA) met with the licensee on 07/07/2023 for the purpose of delivering a finding for a complaint investigation made on 05/05/2023. LPA Bootorabi met with Zahra S Mirfattahi for the purpose of a complaint investigation stated below.
Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to the initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
The allegation: The licensee administers medication to daycare children.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

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 06-CC-20230505083039

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MIRFATTAHI, SEYEDEH ZAHRA	FACILITY NUMBER: 304313893
	VISIT DATE: 07/07/2023

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

The LPA contacted the complainant, and it was stated that a parent called to provide this information to the complainant, and no further information or disclosures were made at this time.

On 05/05/23 during the initial visit, LPA interviewed the licensee with the assistance of Languagelinks (translation services) and the licensee’s daughter’s translation.
The LPA interviewed the licensee on 5/5/2023 regarding the allegations and the licensee declined giving children medication.

LPA interviewed the assistant (A1) on 5/9/2023 and no disclosures of medication were made.

The LPA called 11 parents from the licensee’s LIC 9140 Roster. It was determined that the LIC 9140 was not updated as many numbers were wrong, were no longer in service, or had too many numbers. The LPA spoke with 3 of the 11 parents contacted. 1 of 3 parents disclosed having a suspension of children given medication during the time they were in the licensee’s care.

The LPA conducted interviews and file record reviews. During our initial complaint visit, the LPA toured the home on 5/5/2023 and no medication was observed during the inspection.

Based on interviews conducted and observation, the complaint alleging the licensee administering medication is found to be unsubstantiated. Although the allegation may have happened or is valid, there is not enough preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted, and the report was reviewed and discussed. Notice of the Site Visit was posted during the visit. The facility representative was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100 per day.

Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First-level appeals should be sent to the regional manager at the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817.

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2