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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 483002942
Report Date: 03/25/2026
Date Signed: 03/25/2026 04:04:35 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/09/2026 and conducted by Evaluator Jennifer Patel
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20260109125735
FACILITY NAME:HEAD START - LARSENFACILITY NUMBER:
483002942
ADMINISTRATOR:HARVEY, JOYFACILITY TYPE:
850
ADDRESS:1707 CALIFORNIA DRIVE RM 3TELEPHONE:
(707) 304-2225
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY:28CENSUS: 0DATE:
03/25/2026
UNANNOUNCEDTIME BEGAN:
03:46 PM
MET WITH:Shahla ForsetiTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Child receives unexplained injuries while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jen Patel conducted an unannounced complaint investigation visit to the facility and met with the Director, Shahla Forseti (D1), for the purpose of delivering findings related to the above allegation. LPA Sebastian Phouthavong previously met with Director Shahla Forsati on 01/12/2026 to open the complaint. On 02/25/2026 LPA Jen Patel made a subsequent visit to further investigate the complaint. From 1/12/26-3/11/2026, interviews were conducted with D1, 2 staff (S1-S2), 1 child (C2), and 6 parents (P1-P6) . During the course of the investigation, LPA gathered information, received statements, and made observations of the facility and its equipment. Additional adult interviews were attempted.
D1 denied the allegation that C1 received an unexplained injury while in care. Interviews with S1 and S2 stated their supervision ratio is 1:4, and staff complete health checks upon arrival by visually observing children for bruises, rashes, or other injuries. Observations are documented and parents are informed if concerns are noted.
S1 further stated they have had no big injuries in their classroom that required medical attention. S1 also stated there are times they feel the outdoor area could use more cushioning, as it is mostly cement.
S2 stated the staff take turns to shadow C1. S2 further stated, one staff member is always by C1. S1 stated C1’s body was checked before being picked up on the date of the allegation, and did not observe any injuries. If they had noticed an injury, an ouch report would be completed.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Mohr
LICENSING EVALUATOR NAME: Jennifer Patel
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026
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 01-CC-20260109125735
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: HEAD START - LARSEN
FACILITY NUMBER: 483002942
VISIT DATE: 03/25/2026
NARRATIVE
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P1, P2-P4, P6 stated their overall experience at the facility has been good. P1, P2-P4 stated their child has not come home with an unexplained injury that occurred while in care. P2 stated their child had previously bumped their head, but the facility provided an incident report stating how the injury occurred. P6 further stated one of their children came home with a scratched knee that was not reported on an incident report. P4 and P6 confirmed the staff complete health checks during morning drop-off.

Staff, child, and parent interviews did not corroborate that C1 received unexplained injuries while in care at the facility. Additionally, documents obtained from law enforcement did not support that the injury to C1 occurred while in care at the facility, and no crime was identified at this time.

During the investigation, the LPA did not observe circumstances that would support that child receive unexplained injuries while in care, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation occurred and therefore is determined to be unsubstantiated. There were no Title 22 deficiencies cited. This report was reviewed and discussed with the facility’s Director, Shahla Forseti. Appeal rights were provided. Notice of Site Visit shall be posted for 30 days from today's visit. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Melinda Mohr
LICENSING EVALUATOR NAME: Jennifer Patel
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2