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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 153910434
Report Date: 11/17/2020
Date Signed: 11/30/2020 08:57:39 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/05/2020 and conducted by Evaluator Caroline Harris
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20201105130605
FACILITY NAME:ALCHALATI, WALAA FAMILY CHILD CAREFACILITY NUMBER:
153910434
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
11/17/2020
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Walaa AlchalatiTIME COMPLETED:
01:35 PM
ALLEGATION(S):
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Day care child sustained an injury while in care
INVESTIGATION FINDINGS:
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On 11/17/20 Licensing Program Analyst (LPA) Caroline Harris conducted a telephone call with licensee, Walaa Alchalati in order to close the above complaint investigation. Due to the COVID-19 pandemic, no one is available to conduct an in person visit to close this complaint. The LPA reviewed the allegation and a census was taken. The investigation revealed the following:

The investigation consisted of interviews with the licensee, parents, as well as a facility records review and documentation. The licensee admitted to a child being injured as he/she was rocking on a plastic rocking horse and hit his/her tooth out, when he/she fell. The incident was reported to the Fresno CCL office. The licensee has removed the plastic rocking horse.

Based upon information and interviews conducted, the preponderance of the evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 12, Chapter 3, are being cited on the attached LIC 9099-D.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Caroline HarrisTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2020
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 04-CC-20201105130605
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: ALCHALATI, WALAA FAMILY CHILD CARE
FACILITY NUMBER: 153910434
VISIT DATE: 11/17/2020
NARRATIVE
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An exit interview was conducted with licensee, Walaa Alchalati via telephone call. A copy of this report along with appeal rights were e-mailed to the licensee, Walla Alchalati who was asked to sign the report and send a copy back to the Fresno CCL office.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Caroline HarrisTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 04-CC-20201105130605
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: ALCHALATI, WALAA FAMILY CHILD CARE
FACILITY NUMBER: 153910434
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/17/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/17/2020
Section Cited
CCR
102417(d)
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Operation of a Family Child Care Home. The home shall provide safe toys, play equipment and materials. This requirement was not met as evidenced by a day care child knocking his/her tooth out, when falling off a plastic
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The licensee removed the plastic rocking horse from the facility and will no longer use it for day care children.
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rocking horse, while at the day care facility. This poses a possible risk to the health, safety, or personal rights 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.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Caroline HarrisTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 3