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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 393621889
Report Date: 04/09/2026
Date Signed: 04/09/2026 11:03:02 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. 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
01/23/2026 and conducted by Evaluator Sarah Tibbett
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20260123143433
FACILITY NAME:KHAN, SHAZIAFACILITY NUMBER:
393621889
ADMINISTRATOR:KHAN, SHAZIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 263-9371
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:14CENSUS: 6DATE:
04/09/2026
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Shazia KhanTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Personal Rights: Staff handle daycare children in a rough manner.
INVESTIGATION FINDINGS:
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On 4/9/2026, Licensing Program Analyst (LPA) Sarah Tibbett and Licensing Program Manager (LPM) Bettina Engelman, met with Licensee, Shazia Khan to deliver the findings of the complaint investigation regarding the above allegation. There were 6 children present with 1 assistant.

During the course of the investigation, LPA Tibbett conducted parent and child interviews and obtained information pertaining to the allegations. It was alleged that staff handled children in a rough manner. LPA obtained a video, which licensee had shared with parents. In the short clip taken on or around March 9, 2026, an adult talking to a toddler can be seen grabbing the child by their upper arm in an attempt to direct them to a cat. One of the parents interviewed stated that their child reported being pinched by staff at the facility. Furthermore, 2 out of 6 children who were interviewed disclosed that their ears were pulled by adults in the home.

Report continues on 809-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Sarah Tibbett
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
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-20260123143433
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: KHAN, SHAZIA
FACILITY NUMBER: 393621889
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/10/2026
Section Cited
CCR
102423(a)(4)
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(4) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature...This requirement was not met as evidenced by: Two children disclosed
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Licensee shall submit a written plan on how she and facility staff will honor children's personal rights by POC due date 4/10/2026. The plan will include watching training videos.
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that their ears were pulled by an adult.
A parent reported their child stated he/she was getting pinched by staff and a video showed an adult grabbing a toddler's upper arm to redirect the child. This is an immediate risk to the personal rights and health and safety of 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: Bettina Engelman
LICENSING EVALUATOR NAME: Sarah Tibbett
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 53-CC-20260123143433
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: KHAN, SHAZIA
FACILITY NUMBER: 393621889
VISIT DATE: 04/09/2026
NARRATIVE
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Licensee stated she hasn't seen staff mishandle children, though 1 helper has been known to yell at children. Licensee stated she was unaware that grabbing a child's upper arm was a personal right violation. Licensee also stated she shares videos with parents so they can see what their kids are doing.

Based on the information obtained during the investigation, the evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

The following Title 22 Deficiency is being cited on the subsequent 9099-D page. Upon receipt of Type A citations, licensee shall post and provide copies of the LIC 9099-D for parents/guardians of children in care and for parents/guardians of newly enrolled children for the next 12 months. Licensee must also keep the signed LIC 9224, acknowledging receipt of LIC 9099-D in each child's file.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Sarah Tibbett
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3