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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 393621390
Report Date: 07/18/2025
Date Signed: 09/16/2025 12:33:19 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 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
07/14/2025 and conducted by Evaluator Stacey Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20250714135339
FACILITY NAME:STEPHEN, DAISYFACILITY NUMBER:
393621390
ADMINISTRATOR:STEPHEN, DAISYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 802-7171
CITY:MOUNTAIN HOUSESTATE: CAZIP CODE:
95391
CAPACITY:14CENSUS: 7DATE:
07/18/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Thanaja KumarathasanTIME COMPLETED:
11:20 AM
ALLEGATION(S):
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License:
Licensee is not present in the home the required amount of time
INVESTIGATION FINDINGS:
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** This is an amended report**
On July 18, 2025, Licensing Program Analyst (LPA) Stacey Williams met with Facility Representative, Thanaja Kumarathasan for the purpose of a complaint investigation regarding the allegation listed above. LPA observed 7 children in care supervised by Thanaja and an additional Assistant, Sumathi Ramkumar. Facility Representative informed LPA that Licensee was not home and would not be back until after 2pm. She also stated that she started work at 8:30am. Criminal record clearances were verified.

The facility was toured. LPA spoke to Licensee via telephone. Licensee stated that she left the facility around 9am and would not be back until approximately 2:00pm/2:30pm. LPA informed Licensee of the complaint allegation and reminded Licensee that this is a repeat violation of the same regulation within one year.

Based on today's observations and Licensee's admission of the time frame out of the home, a preponderance of evidence has been met to substantiate the above allegation.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025
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 53-CC-20250714135339
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: STEPHEN, DAISY
FACILITY NUMBER: 393621390
VISIT DATE: 07/18/2025
NARRATIVE
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 ** This is an amended report**
Deficiencies including civil penalties will be cited on subsequent page, LIC 9099D.

Upon receipt of Type A citations, facility shall post and provide copies of the LIC 90009D for parents/guardians of children currently in care and for parents/guardians of newly enrolled children for the next 12 months. Facility must also keep the signed LIC 9224, Acknowledging Receipt of Licensing Reports LIC 9099D in each child's files.

Exit interview conducted at which time the report was reviewed with Facility Representative, Thanaja Kumarathasan. A Notice of Site Visit was posted by LPA Williams and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 53-CC-20250714135339
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: STEPHEN, DAISY
FACILITY NUMBER: 393621390
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/21/2025
Section Cited
CCR
102417(a)
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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.
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** This is an amended report**
Licensee will review regulations pertaining to operation of a family childcare home (102417). Licensee shall submit a statement of understanding that the regulation has been reviewed
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This requirement was not met as evidenced by: Based on observation during today's inspection, LPA learned that the Licensee was not home. Licensee's two Assistants were observed providing care to children.In addition, Licensee acknowledged being away from the home on today's date for more than 20% of operation hours This is an immediate risk to the health and safety of children in care.
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and compliance will be met regarding Licensee's requirement of being present in the facility 80% of the operation hours. Plan of correction date is 07/21/25.
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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: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3