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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434415491
Report Date: 08/06/2019
Date Signed: 08/06/2019 12:34:07 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/27/2019 and conducted by Evaluator Monica Mathur
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20190227115635
FACILITY NAME:MOHAMMED, AZIZAFACILITY NUMBER:
434415491
ADMINISTRATOR:MOHAMMED, AZIZAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 970-9860
CITY:SANTA CLARASTATE: CAZIP CODE:
95050
CAPACITY:14CENSUS: 5DATE:
08/06/2019
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Aziza MohammedTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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9
Daycare child sustained unexplained injuries while in care.

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Subsequent Complaint Investigation at Aziza Mohammed’s family day care home. LPA met with Licensee, Aziza and the finding for the above allegation was delivered. Present in the day care home were five infants with Licensee.

The investigation for the allegation: Daycare child sustained unexplained injuries while in care was conducted by Investigation Branch Special Investigator, Rhonda Austin who reviewed facility records, conducted interviews and obtained relevant documents. Based on the investigation by Investigator Austin, it is concluded the allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

No Deficiencies have been cited for theis allegation. Exit interview conducted with Aziza Mohammed. A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2019
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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