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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343625419
Report Date: 12/12/2025
Date Signed: 12/12/2025 05:44:03 PM

Substantiated


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
09/25/2025 and conducted by Evaluator Dao Vang
COMPLAINT CONTROL NUMBER: 03-CC-20250925100241
FACILITY NAME:KOHISTANI, ILHAMUDINFACILITY NUMBER:
343625419
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:6CENSUS: 6DATE:
12/12/2025
UNANNOUNCEDTIME BEGAN:
03:35 PM
MET WITH:Kohistani, Ilhamudin TIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Licensee is not present 80% of operating hours.
INVESTIGATION FINDINGS:
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On 12/12/2025 at approximately 3:30 PM, License Program Analyst (LPAs) Pa Dao Vang and Payenda Seddiqi conducted a complaint investigation inspection and met with the Licensee, ILhamudin Kohistani. It was alleged the Licensee is not present 80% of operating hours. Upon arrival, LPAs observed two adults (A1 and A2) with background clearance. LPA also observed another adult (A5) with no background clearance.

The Licensee arrived at the facility at 3:35 PM. At 3:39 PM, LPAs observed one preschool-age child and six school-age children arrived at the door alone with no adult.

Throughout the course of the investigation, LPA conducted inspections, made observations, reviewed documentation, and conducted interviews.

Continue on LIC9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2025
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 3
Control Number 03-CC-20250925100241
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: KOHISTANI, ILHAMUDIN
FACILITY NUMBER: 343625419
VISIT DATE: 12/12/2025
NARRATIVE
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On 9/29/2025, LPA Vang arrived at 2:50 PM at the facility and observed two preschool-age children (C1 and C2) supervised by the Licensee’s mother and sister. LPA observed three non-employee adults (A1, A2, and A3) with background clearances and another adult male (A4) with no background clearance in the home. Based on interviews, LPA learned Licensee was at his job and not present in the facility.

At 3:10 PM, three children all under the age of 10 years old, (C3, C4, and C5) arrived. The children arrived alone and were not accompanied by an adult. C3 stated that they live upstairs. C3 also stated that they usually go into the off-limit areas of the living room and bedroom #3.

At 3:12 PM, two preschool-age and one school-age child (C6, C7, and C8) arrived. The children arrived alone and were not accompanied by an adult. LPA observed a child open the door for these newly arrived children.

At 3:15 PM, LPA observed the Licensee parked his car on the street and walked into the home. LPA observed a total of seven daycare children under the age of 10 years old accessing the entire home and entering the off-limit areas. In the interview, Licensee stated that he has called the parents of the children that he’s going to be 10 minutes late and his sister is supervising the children. He stated that this is the first time he’s been late. He also stated that the daycare hours start from 2:30 PM to 5:30 PM Mondays through Fridays.

Based on observations and interviews, the preponderance of evidence results in substantiating the allegations that the Licensee is not present 80% of operating hours. Based on LPA’s observations, interviews, and file reviews, there is a Title 22 deficiency being cited in accordance with California Code of Regulations, (Title 22, Division 12 & Chapter 1), are being cited on the attached LIC9099-D page. The Licensee acknowledges, that for TYPE A DEFICIENCIES ONLY upon receipt, facility shall post LIC 9099-D with Type A deficiency for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the Licensee.
An exit interview, a copy of this report, a copy of the LIC9224 form, and the appeal rights were provided to the Licensee, ILhamudin Kohistani. A Notice of Site Visit is also provided to the Licensee and remains posted for 30 consecutive days. Failure to comply with posting requirements can result in a $100 penalty.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 03-CC-20250925100241
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: KOHISTANI, ILHAMUDIN
FACILITY NUMBER: 343625419
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/13/2025
Section Cited
CCR
102417(a)
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(a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for 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 is not met as evidenced by:
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Licensee requested to add his sister as the co-licensee and will be working with LPA to submit the requried forms.
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Based on observation, the licensee did not comply with the section cited above when licensee, Ilhamudin Kohistani, has not been present in his facility 80% of operating hours per day. Throughout the investigation, LPA observed the Licensee not supervising the children during the facility hours. This poses an immediate health, safety or personal rights risk to 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: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2025
LIC9099 (FAS) - (06/04)
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