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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343623702
Report Date: 11/17/2022
Date Signed: 11/17/2022 11:38:09 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/10/2022 and conducted by Evaluator Gagandeep Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20221110133545
FACILITY NAME:ELIX, MAYESHAFACILITY NUMBER:
343623702
ADMINISTRATOR:ELIX, MAYESHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 743-2129
CITY:SACRAMENTOSTATE: CAZIP CODE:
95826
CAPACITY:14CENSUS: DATE:
11/17/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Mayesha ElixTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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lack of landlord consent.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Gagandeep Singh met with the licensee, Mayesha Elix, for the complaint investigation alleging the licensee providing care for more than 12 children without landlord consent. Purpose of the inspection was explained.

During today’s inspection, LPA inspected the facility and reviewed records. During the record review, it was observed that licensee had 13 children in care during the inspection conducted on August 20, 2021. During the inspection on August 20, 2021, licensee informed the LPA that there were 12 day care children and one licensee’s own newborn child in care. Based on record review and Licensee’s interview, it was found that licensee does not have landlord consent form (LIC9149) signed by landlord on file. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, is being cited on the attached LIC 9099D. Copy of this report is reviewed and provided to the licensee and notice of site visit is posted.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
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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Control Number 03-CC-20221110133545
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: ELIX, MAYESHA
FACILITY NUMBER: 343623702
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/17/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/18/2022
Section Cited
CCR
102417(q)
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A licensee who operates on rented or leased property, and who wishes to increase the capacity of the Family Child Care Home as specified in Section 102416.5(b)(3) or Section 102416.5(d)(2), shall obtain the written consent of the property owner/landlord to increase the home's capacity to eight or 14 children.
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Licensee understands and agree that licensee can not provide care for more than 12 children, unless licensee obtain the written consent from the landlord.
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 This requirement is not met as evidenced as licensee was found providing care for 13 children August 20, 2021 and does not have written consent from the landlord. This poses a potential Health and Safety 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: Natalie Dunaway
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2