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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304313893
Report Date: 06/29/2023
Date Signed: 06/29/2023 04:34:52 PM

Substantiated


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
05/03/2023 and conducted by Evaluator Araceli Bootorabi
COMPLAINT CONTROL NUMBER: 06-CC-20230503150744
FACILITY NAME:MIRFATTAHI, SEYEDEH ZAHRAFACILITY NUMBER:
304313893
ADMINISTRATOR:MIRFATTAHI, SEYEDEH ZAHRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 545-4057
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY:14CENSUS: 9DATE:
06/29/2023
UNANNOUNCEDTIME BEGAN:
12:09 PM
MET WITH:MIRFATTAHI, SEYEDEH ZAHRATIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Licensee inappropriately hitting daycare care several times
Unclear Adult
INVESTIGATION FINDINGS:
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Census upon entry was as followed: 2 Infant / 7 Children Over Two/ 2 Adults Working with children/ 02 Other adults
Licensing Program Analyst (LPA) Araceli Bootorabi & Mila Quinto met with the licensee on 05/29/2023 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 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 consists of the licensee inappropriately hitting a daycare infant child 1 (C1), and elderly people being cared for in the home.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023
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 7
Control Number 06-CC-20230503150744
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: 06/29/2023
NARRATIVE
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The LPA attempted to communicate with the complainant on 5/30/2023 but did not receive a return call.

The LPA interviewed C1’s Parent (P1) on 5/4/2023 and was provided video footage of the incident sent to the LPA. P1 stated received a life photo via text of C1 on 5/3/2023 from the licensee. When P1 reviewed the live image P1 saw the licensee hit C1 on the face. P1 rushed to the licensee’s home to pick up C1 and contacted the police.

On 05/05/23 during the initial visit, LPA interviewed the licensee with the assistance of Languagelinks (translation services) and the licensee’s daughter translating.

During the initial visit conducted on May 5, 2023, the licensee discussed the incident that occurred on May 3, 2023, upon entry with LPA and Licensing Program Manager (LPM). The licensee demonstrated what happened and admitted to hitting C1 in the face to get C1’s attention. The licensee slapped herself on the face to demonstrate what she had done to the LPA and LPM. The LPA received a written declaration from the licensee discussing the incident that occurred on May 3, 2023. In the statement, the licensee stated she “patted” the child on the face and the footage sent to the LPA demonstrates the incident.

LPA interviewed assistant (A1) on 05/09/2023 who stated that on the day of the incident, staff was not present. A1 did not make any discloses of any other incidents nor has S1 witnessed any incidents.

LPA was contacted by Orange County Sheriff’s Department, which confirmed a report was taken.

LPA was not able to qualify any children, due to their ages, all were infants with limited language skills.

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 provided evidence of the incident that occurred on May 3, 2023, and a police report case number. The other two parents interviewed did not make any disclosures.

Based on interviews, the licensee’s statement and written declaration, and video footage the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 & Chapter 3, is cited on the attached LIC 9099D.

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 06-CC-20230503150744
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: 06/29/2023
NARRATIVE
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Allegation: Elderly people are being cared for in the home.

LPA interviewed P1 on 05/04/2023 who stated had read a review on Google Review, stating that the licensee cares for elderly people in the home while operating a daycare home.

During the initial visit conducted on May 5, 2023, LPA conducted a tour with the licensee and observed an elderly person (E1) in bedroom #1. LPA asked the licensee if E1 had a criminal record clearance, and the licensee stated that E1 did not have a clearance. Licensee stated that E1 was a guest for the weekend only and usually only visit on the weekends. The licensee stated E1 was only there for that weekend.

The LPA interviewed Assistant #1 (A1) on 5/9/2023. LPA asked if the licensee cares for elderly people and asked about guests in the home. A1 stated has never seen any other guest or elderly people being cared for by the licensee.

LPA 05/18/2023 LPA received a call from Adult Protective Service stating that during a visit on 05/18/2023 (Thursday) at 12:45 pm, the licensee was caring for an elderly person in bedroom #1

The LPA conducted parent interviews. 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 11 of the parents contacted. 1 of 3 parents stated they have seen an elderly person being cared for in the home by the licensee.

Based on interviews and LPAs observation the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 & Chapter 3, is cited on the attached LIC 9099D.

Due to the Type A violations cited today, the licensee shall post, and provide copies, of the report to parents/guardians of the children in care at the facility by the next business day and shall provide them to the parents/guardians of children newly enrolled at the facility during the next 12 months. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. In addition, the licensee shall immediately post upon receipt of the Proof of Correction for 30 consecutive days.



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.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 06-CC-20230503150744
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: 06/29/2023
NARRATIVE
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 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.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 06-CC-20230503150744
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/30/2023
Section Cited
CCR
102370(a)
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102370(a) Prior to the Department issuing a license, the applicant(s) and all adults residing in the home shall obtain a California criminal record clearance or exemption.
This requirement is not met by by:
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Lincesee stated she will be getting a background check for S.K and submit documentation to licensee. The licensee will be getting the unclear adult background check by tomorrow or maybe today by email.
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 Licensee has uncleared adult living in the home. Sedigheh Kazemi was present in the home duirng the inspection visit on 5/5/2023, 5/18/23 (by LPA Barios) and today's visit as Licensee stated Ms. Kazemi was present yesterday and today.
This poses an immediate health and safety risk to children in care.
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Type A
06/30/2023
Section Cited
CCR
102423(a)(1)
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102423(a)(1)To be treated with dignity in his/her personal relationship with staff and other persons.
This requrement is not met as evidenced by:
Based on interview and record review indicated C1's personal rights was violated.
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Licensee stated she will do her best to impprove her performance. She will tell parents to communicate to licensing about their satisfaction of her child care. Also, I will try my best to have educational activities for the children.
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This poses an immidiated risk of the health and safety of children in care.
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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: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 7
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
05/03/2023 and conducted by Evaluator Araceli Bootorabi
COMPLAINT CONTROL NUMBER: 06-CC-20230503150744

FACILITY NAME:MIRFATTAHI, SEYEDEH ZAHRAFACILITY NUMBER:
304313893
ADMINISTRATOR:MIRFATTAHI, SEYEDEH ZAHRAFACILITY TYPE:
810
ADDRESS:24092 GEMWOOD DRIVETELEPHONE:
(949) 545-4057
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY:14CENSUS: DATE:
06/29/2023
UNANNOUNCEDTIME BEGAN:
12:09 PM
MET WITH:MIRFATTAHI, SEYEDEH ZAHRATIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Daycare child sustained scratches
INVESTIGATION FINDINGS:
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Census upon entry was as followed: 02 Infant / 07 Children 2+ / 02 Adults Working with children/ 02 Other adults
Licensing Program Analyst (LPA) Araceli Bootorabi and Mila Quinto met with the licensee on 06/29/2023 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.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 06-CC-20230503150744
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: 06/29/2023
NARRATIVE
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Allegations: The allegation consists of an infant child (C1) sustaining scratches in daycare.

The LPA attempted to communicate with the complainant on 5/30/2023 but did not receive a callback.

On 05/05/23 during the initial visit, LPA interviewed the licensee with the assistance of Languagelinks (translation services) and the licensee’s daughter translating.

The LPA interviewed the licensee on 5/5/2023 regarding scratches and the licensee declined the incident happening.

The LPA interviewed Assistant #1 (A1). A1 stated during the phone interview that no other unusual incidents had occurred during A1’s time working there.

The LPA interviewed the parent (P1) of C1, and it was stated that C1 received unexplained scratches during the time C1 began care with the licensee. P1 was concerned as P1 had live footage of the licensee hitting the child in the face on 5/3/2023 and was unsure what else the licensee could have done to C1 while in care. P1 did not have photos of the incident.

Based on interviews conducted and observation, the complaint alleging infant child sustaining scratches 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: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023
LIC9099 (FAS) - (06/04)
Page: 7 of 7