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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376100829
Report Date: 11/22/2021
Date Signed: 11/22/2021 11:01:12 AM

Substantiated


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
11/18/2021 and conducted by Evaluator Samantha Clenista
PUBLIC
COMPLAINT CONTROL NUMBER: 51-CC-20211118152842
FACILITY NAME:AGHA MOHAMMADI, MAHDIE FAMILY CHILD CAREFACILITY NUMBER:
376100829
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 1DATE:
11/22/2021
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Mahdie Agha MohammadiTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Licensee is operating beyond the terms and conditions of the license.
INVESTIGATION FINDINGS:
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On 11/22/2021 at 10:20am, Licensing Program Analysts (LPA) Samantha Clenista and Saraliz Velando completed an unannounced complaint inspection for the purpose of investigating and delivering the finding for the above allegation. Upon arrival, LPA's met with Licensee, Mahdie Mohammadi. There were no day care children present, other than Licensee's minor son. During inspection, LPA's utilized Licensee's friend, Afsaneh Tajik, via telephone to translate in Farsi. LPA's interviewed Licensee during inspection. Prior to inspection, LPA's obtained and reviewed outside agency reports related to the above allegation. Licensee admitted operating over capacity in September 2021. Based upon information gathered via Licensee and supporting documents, it has been determined that Licensee operated over her licensed capacity on September 7, 2021 from approximately 3:15pm-4pm by caring for 9 children at one time. There is enough supporting information to prove that the above allegation is to be substantiated. Exit interview was conducted with Licensee. NOTICE OF SITE VISIT IS TO BE POSTED FOR 30 DAYS. LPA's observed Licensee post notice of site visit. See 9099 for cited deficiency.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Samantha Clenista
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2021
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 51-CC-20211118152842
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: AGHA MOHAMMADI, MAHDIE FAMILY CHILD CARE
FACILITY NUMBER: 376100829
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/22/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/26/2021
Section Cited
CCR
102416.5(a)
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Staffing Ratio and Capacity. The capacity specified on the license shall be the maximum number of children for whom care can be provided. Requirement was not met as evidence by:
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Licensee currently has a pending increase capacity application. LPA reviewed the ratio sheet and provided it to Licensee. LPA reviewed the regulation with License and obtained a written statement that she understands the regulation and will not operate over her licensed capacity.
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Based on Licensee's own admission and LPA's review of documentation obtained from an outside agency, it was determined that on September 7, 2021 from 3:15pm-4pm, Licensee operated over her licensed capacity by providing care for 9 children at one time. This poses a Potential Risk to 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: Monica Cuddy
LICENSING EVALUATOR NAME: Samantha Clenista
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2