<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197494902
Report Date: 11/18/2021
Date Signed: 11/18/2021 03:26:07 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/01/2021 and conducted by Evaluator Judy Laureano
COMPLAINT CONTROL NUMBER: 30-CC-20210901132521
FACILITY NAME:SIDDIQUI FAMILY CHILD CAREFACILITY NUMBER:
197494902
ADMINISTRATOR:ASMA SIDDIQUIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(424) 376-8950
CITY:LOMITASTATE: CAZIP CODE:
90717
CAPACITY:14CENSUS: 10DATE:
11/18/2021
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Asma SiddiquiTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights: Licensee did not ensure that day care child was supervised appropriately.
Personal Rights: Child in care was not treated with dignity.

INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11/18/2021 Licensing Program Analyst (LPA) Laureano conducted a complaint inspection to deliver the findings regarding the above-mentioned allegations. LPA met with Asma Siddiqui. LPA explained the purpose of the inspection. There were 10 children in care and 1 staff with licensee providing care.

On 09/07/2021, Licensing Program Analyst (LPA) Miriam Cohen conducted an unannounced complaint investigation with Asma Siddiqui regarding above mentioned allegations. LPA observed the licensee, 5 children and 1 staff.

LPA requested the following: children's roster with Emergency ID, written declarative from licensee.

On 09/07/2021 LPA Cohen conducted investigative interviews with Child #1, Child #2 Child #3 and Child #4. No information was disclosed that children’s personal rights were violated.
On date 09/07/2021 LPA received and reviewed children’s roster with Emergency ID and written declarative from licensee. The information that was collected throughout the investigation was neither evidentiary to approve or disapprove the allegations.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
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 2
Control Number 30-CC-20210901132521
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SIDDIQUI FAMILY CHILD CARE
FACILITY NUMBER: 197494902
VISIT DATE: 11/18/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or disapprove the allegation, therefore the allegation is found to be unsubstantiated.

Exit interview was conducted and a copy of the report was provided
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2