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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343623694
Report Date: 06/20/2023
Date Signed: 06/20/2023 03:21:36 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/05/2023 and conducted by Evaluator Gagandeep Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20230505154912
FACILITY NAME:SAMAHA, JASMINEFACILITY NUMBER:
343623694
ADMINISTRATOR:SAMAHA, JASMINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 287-1235
CITY:SACRAMENTOSTATE: CAZIP CODE:
95815
CAPACITY:14CENSUS: 10DATE:
06/20/2023
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Jasmine SamahaTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Provider did not prevent day care child from being injured by another child in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Gagandeep Singh met with licensee, Jasmine Samaha, to deliver the findings of the above allegation. Purpose of the inspection was explained.

During the investigation, the LPA inspected the facility, conducted the interviews and reviewed the records. It was found that there was a child in care, who got bitten twice while in care. During interviews, it was found that licensee operates with two other helpers and the children are constantly supervised. 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, therefore the allegation is unsubstantiated. Copy of this report was reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for next 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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