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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334845525
Report Date: 11/07/2024
Date Signed: 11/07/2024 04:22:29 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: 13DATE:
11/07/2024
UNANNOUNCEDTIME BEGAN:
02:13 PM
MET WITH:Lubna MahmoodTIME COMPLETED:
04:35 PM
ALLEGATION(S):
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Licensee did not ensure children were supervised at all times.
Licensee did not report incident(s) involving day care child(ren) in care.
INVESTIGATION FINDINGS:
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On November 7, 2024, at 2:04 p.m., Licensing Program Analysts (LPAs), Cindy Hamilton and LPA Brian Morris met with licensee Lubna Mahmood (FCCH) to deliver the findings for the above stated allegations.  During the investigation, LPA Hamilton conducted interviews with licensee, reporting party, one staff, two children and licensee’s child.  LPAs conducted health and safety inspection of the FCCH on 09/12/2024 and issues were noted and cited.  LPA Hamilton obtained and reviewed pertinent documents from the facility’s staff and children’s files.

On September 9, 2024, Community Care Licensing (CCL) received information stating licensee did not ensure children were supervised at all times and licensee did not report incident(s) involving day care child(ren) in care. Regarding allegation licensee did not ensure children were supervised at all times, it was alleged that licensee advised assistant to leave infant and toddlers alone in FCCH while assistant picked up children from school. Licensee confirmed that she advised assistant to leave infants and toddlers strapped down in highchairs and in play yards and that it did happen on two separate occasions,
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Cindy Hamilton
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
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-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: 11/07/2024
NARRATIVE
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dates unknown. Licensee also stated that this occurred as assistant left out the front door and licensee was arriving to the house through the garage. It was also alleged that three children were left in the backyard alone, children left out the side gate and were brought back to the FCCH by a neighbor. Licensee confirmed that this incident did occur.

Regarding the allegation licensee did not report incident(s) involving day care child(ren) in care, it was alleged that a child was injured at the FCCH and parent was not notified. Confidential interviews resulted in conflicting information being provided to LPA. Confidential interview disclosed that the parent was notified via text message, but after further questioning the Licensee was unable to provide text messages to LPA Hamilton as proof. Licensee revealed to LPA that licensee did not report the incident involving three children leaving the backyard of the FCCH. In addition, on September 21, 2024, while LPAs were present, an incident occurred at FCCH (when one of the daycare children arrived after school and refused to come inside), that was not reported to CCL by submitting an Unusual Incident Report (UIR).

Based on confidential interviews and records review, the preponderance of evidence has been met and the allegation licensee did not ensure children were supervised at all times and licensee did not report incident(s) involving day care child(ren) in care are substantiated. The FCCH is being cited for Title 22, Section 102417(a) Operation of a Family Child Care Home and Section 102416.2 (d) Reporting Requirements.

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: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5
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: 11/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/08/2024
Section Cited
CCR
102417(a)
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102417 Operation of a Family Child Care Home (a)The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When...licensee to be temporarily absent from the home...a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day. This requirement was not met as evidenced by:

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Licensee will document plan of supervision to show that children will be supervised at all times.
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Based on confidential interviews licensee did not ensure children in care were supervised at all times, children were left alone in backyard and wandered away and in the home which poses an immediate health, safety or personal rights risk to persons in care.
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Type B
11/27/2024
Section Cited
CCR
102416.2(b)(2)
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102416.2(b)(2) Reporting Requirement: (b) The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home. (2) Any child absence means any instance where a child in care is missing. For example, any child in care who wanders away from the Family Child Care Home, is lost during an outing, or does not return from school, shall be reported even if the child is later found safe. This requirement was not met as evidenced by:

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Licensee will submit unusual incident reports in regard to the incidents in question. Also, the licensee will submit a statement acknowledging an understanding of reporting requirements. Both documents shall be submitted to the department on or before POC due date.

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Based on confidential interviews and records review, the Licensee did not report to the Department multiple incidents regarding children in care. This poses an immediate risk to health, safety or personal rights of persons 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: 11/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
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:3604 FRESSIA STREETTELEPHONE:
(951) 550-6115
CITY:PERRISSTATE: CAZIP CODE:
92571
CAPACITY:14CENSUS: 13DATE:
11/07/2024
UNANNOUNCEDTIME BEGAN:
02:13 PM
MET WITH:Lubna MahmoodTIME COMPLETED:
04:35 PM
ALLEGATION(S):
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Licensee violated children’s personal rights.
Licensee did not ensure that day care children’s diapering needs were met while in care.

INVESTIGATION FINDINGS:
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On November 7, 2024, at 2:04 p.m., Licensing Program Analysts (LPAs), Cindy Hamilton and LPA Brian Morris met with licensee Lubna Mahmood (FCCH) to deliver the findings for the above stated allegations.  During the investigation, LPA Hamilton conducted interviews with licensee, reporting party, one staff, two children and licensee’s children.  LPAs conducted health and safety inspection of the FCCH on 09/12/2024 and issues were noted and cited.  LPA Hamilton obtained and reviewed pertinent documents from the facility’s staff and children’s files.

On September 9, 2024, Community Care Licensing (CCL) received information stating licensee violated children’s personal rights and licensee did not ensure that day care children’s diapering needs were met while in care. Regarding the allegation licensee violated children’s personal rights it was alleged that licensee yells at children, discriminated against children, inappropriately restrained children for hours and hit children. LPA conducted interviews with Staff, children and parents but was unable to corroborate allegation. LPA also conducted pertinent interviews with children, but they did not reveal any violation

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

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
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 5
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: 11/07/2024
NARRATIVE
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of personal rights.

Regarding allegation licensee did not ensure that day care children’s diapering needs were met while in care, it was alleged that licensee does not change diapers. Interview with licensee revealed that licensee changes diapers every two to three hours. Further interviews revealed that the Licensee had an agreement with the assistants regarding this task, and they would take take turns changing the children’s diapers when they were working in the daycare. During LPA’s visit on 9/12/2024, LPA Hamilton did not observe the licensee change any diapers until the issue was brought to the licensee’s attention; however, during this visit, the Licensee was left alone and did not have any assistance while LPAs were on site. During initial visit and on subsequent inspection, LPA did not observe any children in soiled diapers.

Based on confidential interviews and observation, the allegations that licensee violated children’s personal rights and licensee did not ensure that day care children’s diapering needs were met while in care, may have occurred, however are not supported or proven by evidence. Therefore, the allegations are unsubstantiated. A copy of this report, notice of site visit, and appeal rights were provided to licensee.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Cindy Hamilton
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5