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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334845525
Report Date: 09/12/2024
Date Signed: 09/12/2024 04:18:35 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, 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
09/09/2024 and conducted by Evaluator Cindy Hamilton
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20240909173535
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: 12DATE:
09/12/2024
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Lubna MahmoodTIME COMPLETED:
04:25 PM
ALLEGATION(S):
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Licensee is operating out of ratio
INVESTIGATION FINDINGS:
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On September 12, 2024, at 1:15 PM, Licensing Program Analysts (LPAs) Cindy Hamilton and Brian Morris, arrived at the facility for the purpose of initiating a complaint investigation regarding the above stated allegation. LPAs conducted a health and safety inspection of the facility (CC), and one concern was observed. Copies of pertinent records were obtained.

On September 9, 2024, Community Care Licensing (CCL) received information stating licensee is operating out of ratio. Upon arrival LPAs observed licensee to have six children present and during tour of facility observed three additional children in one of the bedrooms napping. At approximately 2:40 PM, three additional school age children arrived at the FCCH, making the total number of children present 12 with the licensee. During interview with licensee, licensee advised that she has been without an assistant since Monday, September 9, 2024 and has 10 to 12 children daily.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Cindy Hamilton
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024
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 4
Control Number 10-CC-20240909173535
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: MAHMOOD FAMILY CHILD CARE
FACILITY NUMBER: 334845525
VISIT DATE: 09/12/2024
NARRATIVE
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Based on LPAs observation and confidential interview with licensee, the preponderance of evidence has been met, therefore the above allegation is substantiated, The facility is being cited for Title 22, Section 102416.5(e) Staffing Ratio and Capacity, see LIC 9099-D.

An exit interview was conducted, this report, appeal rights and Notice of Site Visit was explained and provided to licensee. Licensee was reminded that the “Notice of Site Visit” must be posted for 30 consecutive days. Failure to post will result in Civil Penalties of $100.00.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Cindy Hamilton
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 10-CC-20240909173535
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: MAHMOOD FAMILY CHILD CARE
FACILITY NUMBER: 334845525
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/19/2024
Section Cited
CCR
102416.5(e)
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102416.5(e) Staffing Ratio and Capacity (e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). This requirement was not met as evidenced by:
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Licensee has assistants in the process of completing required documentation and will not accept more than six or eight children until has a qualified assistant. Licensee provided signed statement regarding the above and will submit assistants documents to LPA on or before POC due date via email.
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Based on observation and interview, licensee is operating out of ratio. Licensee was observed to have 12 children present at FCCH without an assistant which poses a potential health, safety and or personal rights risk to children in care.
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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: Carlos Martinez
LICENSING EVALUATOR NAME: Cindy Hamilton
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4