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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015700183
Report Date: 08/24/2021
Date Signed: 08/24/2021 09:40:25 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/04/2021 and conducted by Evaluator Morgan Pringle
COMPLAINT CONTROL NUMBER: 52-CC-20210804090147
FACILITY NAME:BAWAZIR, FATIMAFACILITY NUMBER:
015700183
ADMINISTRATOR:BAWAZIR, FATIMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 876-3616
CITY:HAYWARDSTATE: CAZIP CODE:
94545
CAPACITY:14CENSUS: 5DATE:
08/24/2021
UNANNOUNCEDTIME BEGAN:
09:23 AM
MET WITH:Fatima BawazirTIME COMPLETED:
09:40 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Child sustained injury while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 8/24/2021 at 9:23am Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Fatima Bawazir and her husband Abdul Bawazir for the purpose of a Complaint filed against the Licensee.

Based on interviews, and observations conducted it was alleged a child in care sustained injury while in care. 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.

A notice of site visit was given and must remain posted for 30 days.
Appeal Rights were given and discussed. An exit interview was conducted.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
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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