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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073405959
Report Date: 11/07/2023
Date Signed: 11/07/2023 02:46:56 PM

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, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/13/2023 and conducted by Evaluator Nyeesha Blount
COMPLAINT CONTROL NUMBER: 02-CC-20230813101831
FACILITY NAME:KAZMI, SARAHFACILITY NUMBER:
073405959
ADMINISTRATOR:KAZMI, SARAHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 245-0678
CITY:HERCULESSTATE: CAZIP CODE:
94547
CAPACITY:14CENSUS: 6DATE:
11/07/2023
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:KAZMI, SARAHTIME COMPLETED:
03:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights ~ Day care child was not adequately supervised while in care resulting in child sustaining unexplained injuries.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On November 7, 2023 at 01:20 PM Licensing Program Analyst (LPA) Nyeesha Blount, conducted an Unannounced Complaint site inspection to deliver complaint findings. LPA met with Licensee Kazmi, Sarah also present was (1) staff members who are background cleared. LPA advised Licensee of the nature of the inspection. Current Census today is 6 children which consists of (6) preschoolers. LPA obtained a copy of the children's roster, observations and staff interviews were conducted.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. Therefore, the allegation is Unsubstantiated. Exit interview conducted. Appeal rights were discussed and given. This report must be kept available for public review for (3) years. Notice of site visit given.
Unsubstantiated
Estimated Days of Completion: 60
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Nyeesha Blount
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
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 3
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, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/13/2023 and conducted by Evaluator Nyeesha Blount
COMPLAINT CONTROL NUMBER: 02-CC-20230813101831

FACILITY NAME:KAZMI, SARAHFACILITY NUMBER:
073405959
ADMINISTRATOR:KAZMI, SARAHFACILITY TYPE:
810
ADDRESS:175 TANAGER WAYTELEPHONE:
(510) 245-0678
CITY:HERCULESSTATE: CAZIP CODE:
94547
CAPACITY:14CENSUS: 6DATE:
11/07/2023
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:KAZMI, SARAH TIME COMPLETED:
03:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Reporting Requirements ~ Licensee did not follow reporting requirements.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On November 7, 2023 at 01:20 PM Licensing Program Analyst (LPA) Nyeesha Blount, conducted an Unannounced Complaint site inspection to deliver complaint findings. LPA met with Licensee Kazmi, Sarah also present was (1) staff members who are background cleared. LPA advised Licensee of the nature of the inspection. Current Census today is 6 children which consists of (6) preschoolers. LPA obtained a copy of the children's roster, observations and staff interviews were conducted.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. Therefore, the allegation is Unsubstantiated. Exit interview conducted. Appeal rights were discussed and given. This report must be kept available for public review for (3) years. Notice of site visit given.
Unsubstantiated
Estimated Days of Completion: 60
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Nyeesha Blount
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/13/2023 and conducted by Evaluator Nyeesha Blount
COMPLAINT CONTROL NUMBER: 02-CC-20230813101831

FACILITY NAME:KAZMI, SARAHFACILITY NUMBER:
073405959
ADMINISTRATOR:KAZMI, SARAHFACILITY TYPE:
810
ADDRESS:175 TANAGER WAYTELEPHONE:
(510) 245-0678
CITY:HERCULESSTATE: CAZIP CODE:
94547
CAPACITY:14CENSUS: 6DATE:
11/07/2023
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:KAZMI, SARAHTIME COMPLETED:
03:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Other ~ Licensee withheld day care child's possessions upon termination.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On November 7, 2023 at 01:20 PM Licensing Program Analyst (LPA) Nyeesha Blount, conducted an Unannounced Complaint site inspection to deliver complaint findings. LPA met with Licensee Kazmi, Sarah also present was (1) staff members who are background cleared. LPA advised Licensee of the nature of the inspection. Current Census today is 6 children which consists of (6) preschoolers. LPA obtained a copy of the children's roster, observations and staff interviews were conducted.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. Therefore, the allegation is Unsubstantiated. Exit interview conducted. Appeal rights were discussed and given. This report must be kept available for public review for (3) years. Notice of site visit given.
Unsubstantiated
Estimated Days of Completion: 60
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Nyeesha Blount
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3