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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397005971
Report Date: 02/06/2023
Date Signed: 02/06/2023 03:16:50 PM

Substantiated


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 260
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/14/2022 and conducted by Evaluator Stephanie Lor
PUBLIC
COMPLAINT CONTROL NUMBER: 23-CR-20221114164646
FACILITY NAME:KAIR IN HOME SOCIAL SERVICES, INCFACILITY NUMBER:
397005971
ADMINISTRATOR:GURMEET RAJSINGHFACILITY TYPE:
430
ADDRESS:2105 W MARCH LANE, STE 2TELEPHONE:
(209) 954-0614
CITY:STOCKTONSTATE: ZIP CODE:
95207
CAPACITY:28CENSUS: DATE:
02/06/2023
UNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Elkhair Ahmed,, CEOTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Foster Father made inappropriate sexual comments towards foster child while in care.
INVESTIGATION FINDINGS:
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On 2/6/23, Licensing Program Analyst (LPA) Stephanie Lor made an unannounced visit to the above agency to deliver the complaint investigation findings on behalf of Investigation Branch (IB), which was conducted by Investigator Joseph Balarie. LPA Lor met with the CEO.

LPA Lor obtained copies of facility sketch, training certificates, background clearance, written report, youth’s intake documents, Health and Education Passport, Emergency information, Needs and Service Plan, and confidential information sheet. IB Investigator Balarie conducted 11 confidential interviews between November 2022-January 2023.

Based upon IB Investigator Balarie’s observations, interviews, and records reviewed, there is corroboration for the allegation.

(see next page)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rosa Rodriguez
LICENSING EVALUATOR NAME: Stephanie Lor
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023
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 23-CR-20221114164646
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 260
SACRAMENTO, CA 95833
FACILITY NAME: KAIR IN HOME SOCIAL SERVICES, INC
FACILITY NUMBER: 397005971
VISIT DATE: 02/06/2023
NARRATIVE
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 Additionally, FF confirmed that FF made the statements to C3, without realizing that C3 took offense to the statements. C3 reported that the statement made by the FF made C3 feel uncomfortable.

Based on IB Investigator Balarie’s observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Interim Licensing Standards Chapter 1, are being cited on the attached LIC 9099D.

An exit interview was conducted with the CEO. A copy of this report and the Appeal Rights were provided to the agency.

SUPERVISORS NAME: Rosa Rodriguez
LICENSING EVALUATOR NAME: Stephanie Lor
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 23-CR-20221114164646
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 260
SACRAMENTO, CA 95833

FACILITY NAME: KAIR IN HOME SOCIAL SERVICES, INC
FACILITY NUMBER: 397005971
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/24/2023
Section Cited
ILS
88487.8(b)(2)
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88487.8 Personal Rights (b) In addition to subsection (a), a Resource Family shall ensure that each child is accorded the following personal rights: (2) To be free from corporal or unusual punishment; infliction of pain; humiliation; intimidation; ridicule; coercion; threat; physical, sexual, emotional, mental, or other abuse; or other actions of a punitive nature including interference with the daily living functions of eating, sleeping, or toileting, or withholding of shelter, clothing, medication, or aids to physical functioning.

This requirement is not met as evidenced by:

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The facility will conduct a training with the Resource Parent on Personal Rights. The certificate will be submitted to LPA Lor via email at stephanie.lor@dss.ca.gov by 2/24/23.
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Based on interviews conducted, it was reported that FF made the statements to C3, which posed a potential Health, Safety of Personal Rights to residents 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: Rosa Rodriguez
LICENSING EVALUATOR NAME: Stephanie Lor
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3