<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 566215915
Report Date: 05/16/2023
Date Signed: 05/16/2023 03:29:16 PM

Substantiated


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
03/22/2023 and conducted by Evaluator Susana Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 17-CC-20230322111044
FACILITY NAME:FAROOK FCC AKA SAFIA'S HOME DAYCAREFACILITY NUMBER:
566215915
ADMINISTRATOR:FATHIMA SAFIA FAROOKFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 256-7872
CITY:AGOURA HILLSSTATE: CAZIP CODE:
91301
CAPACITY:14CENSUS: 9DATE:
05/16/2023
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:FATHIMA SAFIA FAROOKTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Daycare child sustained multiple bruising while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On May 16, 2023 Licensing Program Analyst's (LPA's) Susana Martinez and Daniel Venegas conducted an unannounced inspection to deliver the findings of the above mentioned allegations. LPA's met with the licensee Fathima Safia Farook and advised her of the purpose for the inspection. Together with the licensee, LPA's toured the home. At the time of the inspection there were 9 children and 2 adults present.

The Department received an allegation stating daycare child sustained multiple bruising while in care. On 3/23/2023 LPA Martinez initiated the complaint and conducted an interview with the licensee. When asked if there was any idea as to why licensing was there, licensee stated she had an idea to what the inspection was for. Licensee states she had an angry mom that would complain about everything. Licensee states child's (C1) mother complained about her child getting hurt by another child (C2). Licensee states she did observe C2 grab C1 by the wrist. Licensee states she addressed the situation right away and talked to C2 not to do that to C1.
Continued on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023
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 3
Control Number 17-CC-20230322111044
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: FAROOK FCC AKA SAFIA'S HOME DAYCARE
FACILITY NUMBER: 566215915
VISIT DATE: 05/16/2023
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
Licensee states that C2 is very hyper active, and has advised C2's mother about it. Licensee states C1 would remember about things that C2 would do C1 and would bring it up again. Licensee stated she currently did not have an assistant. LPA observed licensee struggling with children supervision.

LPA also conducted an interview with the reporting party (RP) who stated that on several occasions C1 would come home with marks arms and lips. On one occasion when C1 was being picked up RP overheard the licensee talking to a parent about their child (C2). Licensee was telling the parent that C2 had hurt another child that day. When C2's parent left, the licensee told the RP that the child she was referring to was C1. RP states that the licensee admitted that it occurred frequently and that other children in care complain about C2. The RP also mentioned C2 tends to target C1 more. The RP submitted pictures of C1's bruises which were also shown to the licensee. Licensee told RP that she did not know how those injuries happened, but did not deny that they occurred while under her supervision.

Based on LPAs observations, interviews which were conducted, documents gathered and record review(s), the preponderance of evidence standard has been met, therefore the above allegation is found SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 or Health and Safety Code, are being cited on the attached LIC 9099D.

Exit interview conducted with Licensee Safia Farook. A copy of the Appeal Rights (LIC 9058 FAS 01/16) were given and explained. Licensee’s signature on this form acknowledges receipt of these rights.

A notice of site visit was given which must remain posted for a minimum of 30 days.
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 17-CC-20230322111044
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: FAROOK FCC AKA SAFIA'S HOME DAYCARE
FACILITY NUMBER: 566215915
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/30/2023
Section Cited
CCR
102417(a)
1
2
3
4
5
6
7
102417 Operation of a Family Child Care Home(a)The licensee shall be present in the home and shall ensure that children in care are supervised at all times...Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day. This requirement was not met by evidence by:
1
2
3
4
5
6
7
The licensee is to submit a written plan of correction to the department on how she plans on maintaining supervision of all children at all times by 05/30/23. Licensee is also invited for an in office informal meeting that will be set at a later time.
8
9
10
11
12
13
14
Based on LPAs observation, interview, record review, the licensee did not comply with the section cited above in 1 out of 1 counts, licensee admitted that C1 was hurt by C2 for lack of supervision which poses/posed a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: George Mingle
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3