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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397005971
Report Date: 04/18/2023
Date Signed: 04/18/2023 10:28:13 AM

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 260
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/24/2023 and conducted by Evaluator Stephanie Lor
PUBLIC
COMPLAINT CONTROL NUMBER: 23-CR-20230124161229
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:
04/18/2023
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Gurmeet Singh, AdministratorTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Resource Parent handled child in a rough manner.
INVESTIGATION FINDINGS:
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On 4/18/23 , Licensing Program Analyst (LPA) Stephanie Lor made an unannounced visit to the above agency to deliver the complaint investigation findings. LPA Lor met with the Administrator.

Prior to the meeting, LPA Lor reviewed the agency's file at the licensing office, including the complaint history, criminal background check, incident reports and facility personnel report summary. LPA conducted the 10-day inspection of the facility on 1/27/23 and the resource home on 2/13/23. No deficiencies were cited at that time. LPA obtained copies of cps referral, team notes, quarterly progress notes, facility sketch, Needs and Service plan, incident reports, training certificates, health and education passport, and safe written reports. LPA conducted 6 confidential interviews between February 2023-March 2023.

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

DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023
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 2
Control Number 23-CR-20230124161229
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: 04/18/2023
NARRATIVE
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Based on the interviews conducted, there were inconsistent statements made from C1. C1 reported to another staff that C1 was pulled off the bike by FM. During LPA’s interview with C1, C1 reported getting hit and punched in the ribs by FM. S1 and S2 reported that C1 stated that C1 got punched and kicked on the side. Staff observed no bruises or marks on C1. Staff reported having no concerns for the home. C1 also reported feeling “safe and good” in the home.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. No deficiencies were cited.

An exit interview was conducted with the Administrator. A copy of this report was provided to the agency.

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

DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2