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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 393621889
Report Date: 05/25/2023
Date Signed: 05/25/2023 01:48:32 PM

Unsubstantiated


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
04/25/2023 and conducted by Evaluator Erwin Tjhia
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20230425090837
FACILITY NAME:KHAN, SHAZIAFACILITY NUMBER:
393621889
ADMINISTRATOR:KHAN, SHAZIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 263-9371
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:14CENSUS: 9DATE:
05/25/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Shazia KhanTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Facility is operating over capacity
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Erwin Tjhia met with Licensee, Shazia Khan to deliver findings of the complaint investigation regarding the above allegation. There were 9 children and 2 staff during the visit.

Throughout the investigation, LPA conducted observation and interviewed parents, staff, neighbor, and children. It was alleged that the provider operated over the licensed capacity of 14, and that the licensee took some children to a neighbor’s house during the last licensing visit. The individual making the allegation was interviewed and stated that she was satisfied with the care children received at the facility; and she did not provide any additional information. Interviews with licensee and staff revealed that the children were always in the house and were supervised by her and her staff. Parents who were interviewed stated that they never saw the facility operating over the licensed capacity of 14, and that children were always at the facility. Interviews with children revealed that they were always at the facility and never went to stay at another house. Interview with the neighbor revealed that licensee has not dropped children off at his residence.
Report Continue on 809-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
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 2
Control Number 53-CC-20230425090837
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: KHAN, SHAZIA
FACILITY NUMBER: 393621889
VISIT DATE: 05/25/2023
NARRATIVE
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Licensee explained that she has taken daycare children with her when going to the neighbor’s house to ask for groceries she ran out of. However, she stated that the children are never left in the care of the neighbor, and that they all come back to the facility with her.

Based on conflicting statements and lack of clear corroborating evidence, the above allegations could not be substantiated or dismissed. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the finding is UNSUBSTANTIATED.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2