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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434415491
Report Date: 04/07/2022
Date Signed: 04/07/2022 02:29:33 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, 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
03/17/2022 and conducted by Evaluator Anna Morales
COMPLAINT CONTROL NUMBER: 07-CC-20220317115543
FACILITY NAME:MOHAMMED, AZIZAFACILITY NUMBER:
434415491
ADMINISTRATOR:MOHAMMED, AZIZAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 970-9860
CITY:SANTA CLARASTATE: CAZIP CODE:
95050
CAPACITY:14CENSUS: 6DATE:
04/07/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Aziza MohammedTIME COMPLETED:
02:35 PM
ALLEGATION(S):
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1. Personal Rights- Licensee does not ensure a safe and healthful environment
2. Personal Rights- Licensee locks day-care children in the bathroom
3. Personal Rights- Licensee spanks children in care
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Anna Morales and Mel Matos conducted a Subsequent investigation for the above noted allegations. LPAs were greeted by Licensee Aziza Mohammed. LPAs observed five preschool children and one infant.
Complainant alleges that, Licensee does not ensure a safe and healthful environment,
Licensee locks day-care children in the bathroom and Licensee spanks children in care.



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Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Anna MoralesTELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022
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 5
Control Number 07-CC-20220317115543
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MOHAMMED, AZIZA
FACILITY NUMBER: 434415491
VISIT DATE: 04/07/2022
NARRATIVE
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LPAs obtained information from interviews that were conducted with the Licensee, parents, other parties involved, observations, and reviewed supporting documentation. It is concluded that Licensee does not ensure a safe and healthful environment, Licensee locks day care children in the bathroom and Licensee spanks children in care. The preponderance of evidence standard has been met and the allegations noted on this complaint are found to be SUBSTANTIATED.

California Code of Regulations, (Title 22, Division 12 & Chapter 1 number), are being cited on the attached LIC 9099-D. A notice of site visit was issued and posted near the facility entrance along with today's report & Type "A" deficiencies and must remain posted for 30 consecutive days. Licensee must provide copies of this report along with Type "A" deficiency to parents/guardians of children in care at this facility and to parents/guardians of children newly enrolled at this facility during the next 12 months.

Exit interview was conducted with Licensee. Appeals rights were given.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Anna MoralesTELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 07-CC-20220317115543
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MOHAMMED, AZIZA
FACILITY NUMBER: 434415491
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/08/2022
Section Cited
CCR
102423(a)(2)
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102423(a)(2) Personal Rights:
(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of
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Licensee stated that she will submit a written plan to ensure that the she adheres to the manufacturer's instructions at all times and to submit it by the POC date.
AB633 Parent Notification is required.
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consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following:(2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This was not met by: Based on interviews and observation, the Licensee used a booster seat chair in the day care not in accordance with the manufacturer's instructions. This poses an immediate risk to the Health, Safety or Personal Rights to children in care.
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AB633 Parent Notification is required. This page shall be provided to all parents of children currently enrolled and any future children being enrolled for the next 12 months per AB633 requirements.
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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: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Anna MoralesTELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 07-CC-20220317115543
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MOHAMMED, AZIZA
FACILITY NUMBER: 434415491
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
04/08/2022
Section Cited
CCR
102423(a)(4)
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102423(a)(4) Personal Rights:
Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of
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Licensee stated that she will submit a written plan to ensure that the children's personal rights are not violated by the POC date.
AB633 Parent Notification is required.
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consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning. This was not met by: Based on interviews, Licensee spanks the children in care. This poses an immediate risk to the Health, Safety or Personal Rights to children in care.
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AB633 Parent Notification is required. This page shall be provided to all parents of children currently enrolled and any future children being enrolled for the next 12 months per AB633 requirements.
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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: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Anna MoralesTELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 07-CC-20220317115543
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MOHAMMED, AZIZA
FACILITY NUMBER: 434415491
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
04/08/2022
Section Cited
CCR
102423(a)(4)
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102423(a)(4) Personal Rights:
Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of
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Licensee stated that she will submit a written plan to ensure that the children are never locked in the bathroom as POC(proof of correction) by the due date.
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consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning. This was not met by: Based on interviews, Licensee has locked day care children in the bathroom located in the main day care room. This poses an immediate risk to the Health, Safety or Personal Rights to children in care.
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AB633 Parent Notification is required. This page shall be provided to all parents of children currently enrolled and any future children being enrolled for the next 12 months per AB633 requirements.
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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: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Anna MoralesTELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5