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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 503904174
Report Date: 07/13/2022
Date Signed: 07/13/2022 12:28:33 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, 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
05/19/2022 and conducted by Evaluator Joseph Pacheco
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20220519133027
FACILITY NAME:KHOSHABA, NAHRAIN FAMILY CHILD CAREFACILITY NUMBER:
503904174
ADMINISTRATOR:KHOSHABA, NAHRAINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 622-0244
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:14CENSUS: 12DATE:
07/13/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Nahrain Khoshaba - LicenseeTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Licensee abused day-care child
INVESTIGATION FINDINGS:
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On 7/13/22, Licensing Program Analyst (LPA) Joseph Pacheco conducted an unannounced complaint inspection. LPA met with Licensee, Nahrain Khoshaba. The purpose of the inspection was to deliver the findings for the above complaint allegation. LPA interviewed day care children during today's inspection.
During the course of the investigation, LPA interviewed Complainant, Licensee, Assistant, day care parents, day care children, City of Modesto Police Officer and Stanislaus County Child Protective Services Social Worker. Based on information obtained during the investigation, there is a preponderance of the evidence to substantiate the allegation that Licensee abused a day care child. The finding of this allegation is substantiated.
Per California Code of Regulations, Title 22, Division 12, Chapter 3 the following deficiency is found (See LIC9099-D): Upon receipt, Licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. Licensee has been informed that she will be required to attend a non-compliance meeting at the Fresno Regional Child Care Office.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Joseph Pacheco
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022
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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Control Number 04-CC-20220519133027
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: KHOSHABA, NAHRAIN FAMILY CHILD CARE
FACILITY NUMBER: 503904174
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
07/15/2022
Section Cited
CCR
102423(a)(4)
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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 consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (4) To be free from corporal or unusual
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Licensee was provided paperwork regarding physical punishment. Licensee is to read this paperwork, answer the questions outlined and provide a written statement on what she learned to Community Care Licensing by 7/15/22. A Non-Compliance Conference will be scheduled at the Fresno Regional Child Care
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punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature. This requirement was not met as evidenced by information obtained during the investigation. This is an immediate danger to the health, safety and personal rights of children in care.
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Office to discuss the allegation.
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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.
SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Joseph Pacheco
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022
LIC9099 (FAS) - (06/04)
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