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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 372013158
Report Date: 01/19/2024
Date Signed: 01/19/2024 01:10:00 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 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
01/17/2024 and conducted by Evaluator Nancy Diaz
COMPLAINT CONTROL NUMBER: 51-CC-20240117134857
FACILITY NAME:USMAN, MAHJABEEN FAMILY CHILD CAREFACILITY NUMBER:
372013158
ADMINISTRATOR:USMAN, MAHJABEENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 566-7130
CITY:SAN DIEGOSTATE: CAZIP CODE:
92126
CAPACITY:14CENSUS: 9DATE:
01/19/2024
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Mahjabeen UsmanTIME COMPLETED:
01:20 PM
ALLEGATION(S):
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1. Child sustained unexplained injury while in care.
2. Staff did not ensure adequate care and supervision was provided to children in care.
INVESTIGATION FINDINGS:
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On 1/19/24 @ 11:45AM, Licensing Program Analyst (LPA) Nancy Diaz conducted an unannounced inspection in reference to the above allegations. LPA met with Mrs. Usman. Observed present today were 9 daycare children and 2 helpers - Keari Jones & Jessica Martinez. LPA interviewed the licensee and the 2 helpers.
It was alleged that a daycare child sustained unexplained injury while in care and that staff did not ensure adequate care and supervision to children in care. Based on the information obtained during interviews, observations, and documentation reviewed it is determined that the above allegations are unsubstantiated.
Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the above allegations is found to be Unsubstantiated. Exit interview conducted and report was reviewed with Mrs. Usman. A notice of site visit and appeal rights were given and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joelle ReddingTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 929-2327
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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