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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 394500403
Report Date: 09/09/2022
Date Signed: 09/09/2022 02:53:29 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
07/28/2022 and conducted by Evaluator Nola Maestas
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20220728143200
FACILITY NAME:KHAN, RABEEHAFACILITY NUMBER:
394500403
ADMINISTRATOR:KHAN, RABEEHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 331-4776
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:14CENSUS: DATE:
09/09/2022
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Rabeeha KhanTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Children play in unfenced front yard without supervision
INVESTIGATION FINDINGS:
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On 09/09/2022, Licensing Program Analyst Katy Maestas (LPA) conducted an unannounced field visit to deliver the findings for the above allegation. LPA arrived at the Family Childcare Home (FCCH) and was met by Licensee Rabeeha Khan (L1). LPA disclosed the purpose of the inspection and was granted entrance. LPA toured the facility and observed 8 children being supervised by Licensee and Aide during naptime. LPA determined through accessing Guardian that all required adults were background cleared.

Throughout the course of the investigation, LPA reviewed the facility’s file, collected documents pertaining to the allegation, and conducted observations and interviews. It was alleged that children were playing in the front yard where an alley way is located, and that L1 was not supervising the children. Interviews did not reveal corroboration, and the above allegation could not be substantiated or dismissed.

CONTINUED ON 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Nola Maestas
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022
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-20220728143200
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, RABEEHA
FACILITY NUMBER: 394500403
VISIT DATE: 09/09/2022
NARRATIVE
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Based on interviews, observations, and documentation, there was not a preponderance of evidence to prove or negate the allegation, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted with L1 and Appeal Rights were provided. A Notice of Site Visit was posted by LPA and this shall be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Nola Maestas
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2