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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 394501130
Report Date: 09/04/2024
Date Signed: 09/04/2024 12:26:20 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
06/06/2024 and conducted by Evaluator Carla Polanco Rivera
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20240606092333
FACILITY NAME:ZUBAIR, FRESHTAFACILITY NUMBER:
394501130
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 1DATE:
09/04/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Licensee Freshta ZubairTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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Criminal record clearance: Unceared adults living in the Family Child Care Home.
License: Licensee does not live in the Family Child Care Home.
Phyisical plant: Licensee did not keep home free of mold.
INVESTIGATION FINDINGS:
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On 9/4/24, Licensing Program Analyst (LPA) Carla Polanco and Licensing Program Manager (LPM) Karyn Guerra conducted an unannounced field visit to deliver the findings for the above allegations. LPA and LPM met with Licensee Frehsta Zubair. Throughout the course of the investigation, LPA conducted observations, interviews, reviewed and collected documents.

It was alleged that there are uncleared adults residing in the Family Child Care Home (FCCH). On a visit conducted on 6/12/24, LPA met with the Licensee who acknowledged that two adults in the home had not been fingerprinted, a citation and civil penalty were assessed during the visit. Based on interviews and file reviews, the preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED.

CONTINUED ON LIC 9099-C......
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024
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 3
Control Number 53-CC-20240606092333
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: ZUBAIR, FRESHTA
FACILITY NUMBER: 394501130
VISIT DATE: 09/04/2024
NARRATIVE
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It was alleged that the licensee does not permanently reside in the FCCH. Interviews conducted by LPA revealed that Licensee does not live in the FCCH. On 6/11/24, LPA came to learn that other renters reside in the home and are currently renting the home from the Licensee. LPA conducted additional interviews with neighbors and gathered documentation that show the preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED.

It was alleged that Licensee did not keep the home free of mold. There was a reported concern that the garage area of the home has mold and Licensee did nothing to fix it. During an inspection conducted by LPA on 6/12/24, the garage area of the home was toured. Licensee stated that there had been a leak in the water heater which caused mild mold in the vicinity of the water heater, but the leak had been fixed prior to the tenant moving into the home. LPA observed no leak on the water heater, but did observe some mold residue on the sheet rock under the water heater and on the ceiling near the water heater area. Based upon interviews conducted and observations while at the facility, the preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED.

Licensee was made aware that Title 22 regulations are being cited on an attached 9099-D page.



An exit interview was conducted with Licensee Freshta Zubair 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.

LPA informed the Facility Representative they must provide a copy of this licensing report dated 09/04/24 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 53-CC-20240606092333
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: ZUBAIR, FRESHTA
FACILITY NUMBER: 394501130
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/09/2024
Section Cited
CCR
102352(H)(1)
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(h) (1) "Home" means the licensee's residence as defined by Government Code Section 244.
This requirement is not met as evidenced by:
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Licensee states that she will provide POC by due date and LPA will conduct a follow up inspection.
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Based on interviews and observations, the licensee did not comply with the section cited above in which poses an immediate health, safety or personal rights risk to persons in care.
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Type B
09/09/2024
Section Cited
CCR
102417(b)
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(b)The home shall be kept clean and orderly, with heating and ventilation for safety and comfort.
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Licensee states that she will have the mold cleaned and provide evidence of POC by due date.
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Based on interviews and observations, the licensee did not comply with the section cited above in which poses an immediate health, safety or personal rights risk to persons 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: Karyn Guerra
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024
LIC9099 (FAS) - (06/04)
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