Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 426210319
Report Date: 10/14/2016
Date Signed 10/14/2016 01:50:44 PM


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/22/2016 and conducted by Evaluator Maria Mueller
PUBLIC
COMPLAINT CONTROL NUMBER: 17-CC-20160922120600
FACILITY NAME:KHODARAHM FCC AKA ANGEL FAMILY CHILD CAREFACILITY NUMBER:
426210319
ADMINISTRATOR:BEHJAT KHODARAHMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 968-7838
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY:14CENSUS: 5DATE:
10/14/2016
UNANNOUNCEDTIME BEGAN:
12:24 PM
MET WITH:Behjat KhodarahmTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Personal Rights - Child strapped in stroller.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Maria Mueller conducted a complaint investigation regarding allegation above. Complainant indicated that in more than one occassion, that complainant observed a child strapped in a stroller. Licensee and Staff #1 (confidential list) were interviewed and informed LPA that child #1 (confidential list) was enrolled at the day care. C1 stayed at the FCCH for approxiimately 3 1/2 days. C1 was transitioning to the home, and as soon as parent left, C1 would start crying. C1 liked assistant and stayed with her but continued to cry, looking for C1's mother. S1 stated that even during music hours, C1 did not want to stay with the group, and was playing in the play room with S1. C1 wants to be held most of the time, and did not want to leave assistant, and continued to cry. C1 refused to walk or play outdoors with other children. C1 was placed in a stroller. S1 stated that C1 was clinging to her, and did not want to leave her side. C1 was strapped in the stroller and was rocked back and forth, and was pushed around in the backyard to soothe her, while other children were playing. Licensee stated that child #1 was placed in the stroller approximately 1 hour, and sometimes less than 30 minutes. S1 stated that the purpose of the strollers outside is to put the children outside, and to be outside with other children. S1 stated that C1 was placed in the stroller no longer than 5 minutes. S1 stated that C2 and C3 were placed in the stroller as well, and stayed longer in the stroller than C1.
Continued on next page 9099 C and 9099 D
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Deborah AjaoTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Maria MuellerTELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2016
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 4


Control Number 17-CC-20160922120600

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: KHODARAHM FCC AKA ANGEL FAMILY CHILD CARE
FACILITY NUMBER: 426210319
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/17/2016
Section Cited
102423(a)(2)
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Personal Rights. Each child shall be accorded safe, healthful and comfortable
accommodations,
Licensee stated that children were placed, strapped in the stroller for an hour, half an hour and sometimes 5 minutes when other children (older children) are playing outdoors. Licensee stated that C1 did not want to walk, and did not want to play. S1 stated that she rocked the stroller back and forth to calm C1.
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Licensee removed the stroller in the home. Licensee stated that she will no longer use the stroller to keep children restrained.
Licensee will submit a plan of correction on how children will be provided an alternative outdoor play that is age appropriate and will not be restrained / strapped in strollers by October 17, 2016.
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S1 stated that C1 was strapped in the stroller no longer than 5 minutes. Licensee stated that children play outside, and C1 did not want to join the other children and walk. C2 and C3 were also strapped in the stroller while children are playing outdoors. Stroller were not being used for what it is designed for transporting children, like walks and going to stroll.
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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.
SUPERVISOR'S NAME: Deborah AjaoTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Maria MuellerTELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2016
LIC9099 (FAS) - (06/04)
Page: 2 of 4



Control Number 17-CC-20160922120600
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: KHODARAHM FCC AKA ANGEL FAMILY CHILD CARE
FACILITY NUMBER: 426210319
VISIT DATE: 10/14/2016
NARRATIVE
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Parents of children currently enrolled and no longer enrolled at this day care home were interviewed by LPA. None of the parents interviewed have issues or concern regarding the Family Child Care Home.

C1, C2 and C3 are no longer enrolled at this FCCH. Licensee removed the stroller from the home.

Based on LPAs observations and interviews which were conducted and record review (s), the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22 Division 12 and Chapter number 102423(a)(2)), are being cited on the attached LIC 9099 D.

Appeal rights given and explained to licensee.

Upon receipt of this report, licensee shall post for 30 days and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide LIC 9224 form for each child in care and have each parent sign the form that they have received a copy of the report LIC 9099, LIC 9099 C and LIC 9099 D.



THIS REPORT MUST BE FILED IN FACILITY FILE AND MADE AVAILABLE FOR PUBLIC REVIEW FOR 3 YEARS.

SUPERVISOR'S NAME: Deborah AjaoTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Maria MuellerTELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2016
LIC9099 (FAS) - (06/04)
Page: 3 of 4