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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334845525
Report Date: 05/23/2024
Date Signed: 05/23/2024 12:47:39 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/08/2024 and conducted by Evaluator Jesse Gardner
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20240508084035
FACILITY NAME:MAHMOOD FAMILY CHILD CAREFACILITY NUMBER:
334845525
ADMINISTRATOR:MAHMOOD, LUBNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 550-6115
CITY:PERRISSTATE: CAZIP CODE:
92571
CAPACITY:14CENSUS: 8DATE:
05/23/2024
UNANNOUNCEDTIME BEGAN:
12:03 PM
MET WITH:Lubna Mahmood, LicenseeTIME COMPLETED:
01:07 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee did not ensure that a child was treated with dignity and respect
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jesse Gardner conducted an unannounced subsequent complaint visit to the facility. LPA met with Licensee Lubna Mahmood and informed them of the purpose of this visit. During this investigation LPA conducted interviews with staff, children, and confidential witnesses, and obtained supportive documentation for review to assist with determining the findings for the above noted allegation. The following was determined.

It was alleged that the Licensee did not ensure that a child was treated with dignity and respect. It was further stated that approximately one year before reporting, Child One (C1) was made to wear a diaper and was locked in a bathroom with other children in the day care laughing at them.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024
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 10-CC-20240508084035
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: MAHMOOD FAMILY CHILD CARE
FACILITY NUMBER: 334845525
VISIT DATE: 05/23/2024
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
Confidential witness interview stated that C1 was potty trained upon enrollment; thus, C1 would not wear diapers upon drop off to the facility. Staff interview indicated that C1 had behavioral challenges, and would often defecate in their pants, and otherwise would not adhere to facility rules (such as sleeping where other children slept or participate in activities with other children). 1 of 3 children interviewed stated that C1 was disruptive and would often defecate in their pants. Staff interview stated that C1 would have incontinent issues and would often defecate in their pants and due to this, C1 was regularly placed in a diaper by staff. Interview with C1 relayed that they felt sad when placed in a diaper. Staff interview denied C1 ever being locked in a bathroom. Confidential witness interview revealed no recollection of the incident where C1 was locked in a bathroom. Based on staff, confidential witness and children interviews conducted, the regulatory requirement to be treated with dignity and respect was not met. The allegation was therefore, Substantiated.

A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

An exit interview was conducted where a copy of this report was provided along with a copy of the LIC9099D, LIC811, and Appeal Rights.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/08/2024 and conducted by Evaluator Jesse Gardner
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20240508084035

FACILITY NAME:MAHMOOD FAMILY CHILD CAREFACILITY NUMBER:
334845525
ADMINISTRATOR:MAHMOOD, LUBNAFACILITY TYPE:
810
ADDRESS:3604 FRESSIA STREETTELEPHONE:
(951) 550-6115
CITY:PERRISSTATE: CAZIP CODE:
92571
CAPACITY:14CENSUS: 8DATE:
05/23/2024
UNANNOUNCEDTIME BEGAN:
12:03 PM
MET WITH:Lubna Mahmood, LicenseeTIME COMPLETED:
01:07 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee did not prevent an adult in the home from yelling at a child
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jesse Gardner conducted an unannounced subsequent complaint visit to the facility. LPA met with Licensee Lubna Mahmood and informed them of the purpose of this visit. During this investigation LPA conducted interviews with staff and residents; obtained supportive documentation for review to assist with determining the findings for the above noted allegation. The following was determined. It was alleged that the Licensee did not prevent an adult in the home from yelling at a child. 3 of 3 Staff interviews revealed that staff or others in the home have not ever yelled at children in care. 4 of 4 confidential witnesses reported that the Licensee is always pleasant as well as other staff in the facility and that no one has ever witnessed (continued on LIC9099C)
This is an amended document originally dated 5/23/24.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024
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 5
Control Number 10-CC-20240508084035
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: MAHMOOD FAMILY CHILD CARE
FACILITY NUMBER: 334845525
VISIT DATE: 05/23/2024
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
or heard anyone yelling at the children in care. 3 of 3 children interviews relayed that staff are always nice, and no one has ever heard anyone yelling at other children. Therefore, based on interviews conducted, the allegation could not be corroborated, nor refuted. There were no other witnesses or evidence available at this time to examine; therefore, the allegation was Unsubstantiated.

A finding of UNSUBSTANTIATED means that 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.

An exit interview was conducted where a copy of this report was provided along with a copy of the Appeal Rights.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 10-CC-20240508084035
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: MAHMOOD FAMILY CHILD CARE
FACILITY NUMBER: 334845525
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/06/2024
Section Cited
CCR
102423(a)(1)
1
2
3
4
5
6
7
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 consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following:
(1) To be treated with dignity in his/her personal relationship with staff and other persons. This requirement was not being met as evidenced by:
1
2
3
4
5
6
7
Licensee states that they will conduct in-service training with all staff on the cited regulation and provide proof of such to LPA by POC date.
8
9
10
11
12
13
14
Based on staff, and confidential interviews conducted, C1 was placed in a diaper when C1 did not require one. This is a potential personal rights risk to children in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5