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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 394500745
Report Date: 03/28/2024
Date Signed: 03/29/2024 03:39:58 PM

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
01/11/2024 and conducted by Evaluator Elvira Sierra
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20240111123407
FACILITY NAME:DUBEY, SHIKHAFACILITY NUMBER:
394500745
ADMINISTRATOR:SHIKHA DUBEYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(669) 262-9993
CITY:TRACYSTATE: CAZIP CODE:
95304
CAPACITY:14CENSUS: 5DATE:
03/28/2024
UNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Shikha DubeyTIME COMPLETED:
03:35 PM
ALLEGATION(S):
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Personal Rights-Child sustained unexplained injuries while in care.
Personal Rights-Licensee does not ensure that child is properly strapped in highchair.
Personal Rights-Licensee does not follow safe sleeping practices.
INVESTIGATION FINDINGS:
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This is an amended version of a report originally signed on 03/28/24.
On 03/28/24, Licensing Program Analyst (LPA), Elvira Sierra conducted an unannounced inspection visit to deliver findings of the above complaint allegations and met with Licensee,Shikha Dubey. Present in the facility was licensee caring for 5 children. Licensee's assistant arrived later during the inspection.

It was alleged that Child # 1 sustained unexplained injuries while in care and Licensee does not ensure that child is properly strapped in highchair. Also, the Reporting Party (RP) alleged that Licensee does not follow safe sleeping practices. LPA conducted interviews with the Licensee, staff, parents and reviewed pertinent documentation. The licensee admitted that Child #1 was not always buckled in the highchair because child#1 was not comfortable when strapped in. Also,Licensee admitted having used a blanket once while child#1 was sleeping in a crib. LPA advised Licensee that this is not a safe sleeping practice for infants and cribs must be free from all loose articles and objects, including blankets and pillows. Interviews revealed that Child#1 received an injury on12/19/23 while under the Licensee care.
Report continues on subsequent page 809C--
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
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 6
Control Number 53-CC-20240111123407
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: DUBEY, SHIKHA
FACILITY NUMBER: 394500745
VISIT DATE: 03/28/2024
NARRATIVE
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Based on interviews and records review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Type A deficiencies were cited during the visit on the attached LIC 9099 D. Upon receipt of Type A citation, the licensee shall post and provide copies of the LIC 9099D for parents/guardians of children in care and for parents/guardians of newly enrolled children for the next 12 months. The licensee must also keep the signed LIC 9224, acknowledging receipt of LIC 9099D in each child's file.

Exit interview conducted. Appeal of Rights and this report were reviewed and provided to Licensee, Shikha Dubey. Notice of Site Visit posted.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 53-CC-20240111123407
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: DUBEY, SHIKHA
FACILITY NUMBER: 394500745
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/29/2024
Section Cited
CCR
102423(a)(4)
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This is an amended version of a report originally signed on 03/28/24.
102423(a)(4) Personal Rights
(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative.....
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POC; Licensee stated that she will conduct a meeting with staff regarding supervision and reporting injuries. Licensee stated that she will instruct staff to conduct a wellness check of the children every morning during drop off. Licensee will submit a meeting notes and signature of attendees to LPA by due date.
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(4) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation,........This requirement was not met as evidence by; Child #1 received an injury while in care. This is a deficiency that if not corrected poses an immediate risk to the 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: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 53-CC-20240111123407
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: DUBEY, SHIKHA
FACILITY NUMBER: 394500745
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/26/2024
Section Cited
CCR
102425(b)
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102425(b)INFANT SAFE SLEEP
(b) Cribs or play yards shall be free from all loose articles and objects. This requirement was not met as evidenced by: It was revealed during interview and records review that Licensee covered an infant with a blanket while infant was sleeping in a crib.
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POC; Licensee stated that she won't use blankets or any other items in side a crib while children are sleeping. Licensee will discuss sleeping practices with staff and parents. Licensee will send a meeting notes and names of attendees to LPA by due date.
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This is a requirement that if not corrected can pose a risk to the health and safety to the children in care.
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Type B
04/26/2024
Section Cited
CCR
102423(a)(2)
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102423(a)(2) Personal Rights
(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following:
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POC: Licensee stated that she will stop this practice immediately regardless of parents request. Licensee stated that deficiency will also be discuss during a meeting with staff and will submit meeting notes to LPA by due date.
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(2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement was not met as evidence by: Child #1 was not strapped to the highchair during feeding. This is a requirement that if not corrected can pose a risk to the health and safety to the 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: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 6
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
01/11/2024 and conducted by Evaluator Elvira Sierra
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20240111123407

FACILITY NAME:DUBEY, SHIKHAFACILITY NUMBER:
394500745
ADMINISTRATOR:SHIKHA DUBEYFACILITY TYPE:
810
ADDRESS:8775 WEST ETCHEVERRY DRIVETELEPHONE:
(669) 262-9993
CITY:TRACYSTATE: CAZIP CODE:
95304
CAPACITY:5CENSUS: 5DATE:
03/28/2024
ANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Shikha DubeyTIME COMPLETED:
03:35 PM
ALLEGATION(S):
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Personal Righs-Licensee inappropriately restrained child in care.
Personal Rights-Licensee forced child in care to eat
INVESTIGATION FINDINGS:
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On 03/28/24, Licensing Program Analyst (LPA), Elvira Sierra conducted an unannounced inspection visit to deliver findings of the above complaint allegations and met with Licensee Shikha Dubey. Present in the facility was Licensee caring fro 5 children Licensee's assistant arrived later during the inspection.

It was alleged that Licensee inappropriately restrained the child in care by holding Child#1’s arm while feeding her. Reporting Party also alleged that Licensee forced Child#1 to eat. LPA conducted interviews with the Licensee, staff, parents and reviewed pertinent documentation. LPA received conflicting information during interviews. Parents that were interviewed disclosed to have no concerns regarding staff feeding practices. Licensee and staff revealed during interviews that the facility does not force a child to eat. The licensee stated that if a child does not want to eat, she will try to feed the child later, and inform parents if their child is having difficult eating.

Report continues on subsequent page 809C--
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 53-CC-20240111123407
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: DUBEY, SHIKHA
FACILITY NUMBER: 394500745
VISIT DATE: 03/28/2024
NARRATIVE
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Based on the information obtained, there is not a preponderance of evidence to prove the allegations did or did not occur; therefore, the allegations are UNSUBSTANTIATED.

An exit interview was conducted in which the report was reviewed and provided to the Licensee, Shikha Dubey. Appeals of rights were provided and a Notice of site visit was posted and shall remain posted for 30 days.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 6