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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343624549
Report Date: 12/19/2023
Date Signed: 12/19/2023 04:42:59 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
10/23/2023 and conducted by Evaluator Christopher Bello
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20231023164049
FACILITY NAME:FAIZI, PALWASHAFACILITY NUMBER:
343624549
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 8DATE:
12/19/2023
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Palwasha FaiziTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Licensee did not give their landlord notification of their intent to operate a family childcare
Licensee is operating over capacity
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christopher Bello arrived at approximately 4:00pm and met with licensee Palwasha Faizi to close a complaint investigation, regarding the above allegations. Upon arrival, LPA observed six daycare Children including two of the licensee’s minor children under the age of ten. Also present was husband acting as an translator and licensee’s minor children over the age of 10. LPA made observations, gathered documents pertaining to the investigation and conducted interviews with the licensee. It was alleged that licensee was operating out of capacity and did not notify their landlord notification of operation of daycare signing the LIC9151 form. LPA did not observe the facility out of ratio on different occasions. LPA reviewed facility file and observed Landlord Notification on file. Based on LPAs' investigation, the preponderance of evidence standard has not been met, therefore, the above allegations are found to be unsubstantiated.

No Title 22 Deficiencies observed in the areas that were evaluated. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee [or facility representative] Palwasha Faizi.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Christopher Bello
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023
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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