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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 393623096
Report Date: 03/22/2023
Date Signed: 03/22/2023 11:08:37 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 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
02/13/2023 and conducted by Evaluator Carla Polanco Rivera
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20230213094144
FACILITY NAME:KHAN, SUMAILAHFACILITY NUMBER:
393623096
ADMINISTRATOR:KHAN, SUMAILAHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 268-5803
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY:14CENSUS: 7DATE:
03/22/2023
UNANNOUNCEDTIME BEGAN:
09:52 AM
MET WITH:Licensee Sumailah KhanTIME COMPLETED:
10:29 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights: Inappropriate discipline practices
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 3/22/23, Licensing Program Analyst Carla Polanco (LPA) conducted an unannounced field visit to deliver the findings for the above allegation. LPA met with Licensee, Sumailah Khan. Throughout the course of the investigation, LPA conducted observations, interviews, and reviewed and collected documents.
It was alleged that staff pinched a daycare child as a form of discipline. Interviews conducted with parents and staff revealed that the facility does not take part in physical discipline of children. In addition, interviews revealed that parents are notified if there is a concern with a child's behavior, so that parents and staff can work together to solve any issues. LPA witnessed and observed the Licensee properly caring for a child.

Based on the interviews conducted, and the records reviewed, the above allegation was found to be UNSUBSTANTIATED, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted by LPA Carla Polanco with Licensee, and Appeal Rights were provided. A Notice of Site Visit was posted by LPA and shall remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
Unsubstantiated
Estimated Days of Completion: 37
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023
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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