397005971-10-13-2022-23-CR-RROZ-CK7TLQ-20221014144951

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 397005971
Report Date: 10/12/2022
Date Signed: 10/13/2022 08:49:35 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
07/08/2022 and conducted by Evaluator Stephanie Lor

COMPLAINT CONTROL NUMBER: 23-CR-20220708174547

FACILITY NAME:	KAIR IN HOME SOCIAL SERVICES, INC		FACILITY NUMBER:	397005971
ADMINISTRATOR:	GURMEET RAJSINGH		FACILITY TYPE:	430
ADDRESS:	2105 W MARCH LANE, STE 2		TELEPHONE:	(209) 954-0614
CITY:	STOCKTON	STATE:	ZIP CODE:	95207
CAPACITY:	25	CENSUS:	DATE:	10/12/2022
		UNANNOUNCED	TIME BEGAN:	10:51 AM
MET WITH:	Gurmeet Rajsingh, Administrator		TIME COMPLETED:	11:10 AM

ALLEGATION(S):

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Hazardous items are accessible to foster child.

INVESTIGATION FINDINGS:

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On 10/12/22 at 10:51am, 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 and the resource home on 7/15/22. No deficiencies were cited at that time. LPA obtained copies of Intake Paperwork, Needs and Service Plan, CFT Meeting Notes, IEP’s, Health and Education Passports, FFA Quarterly Reports, Facility Sketch, Home Study/Family Evaluation/Written Report, recent Case Notes, and Training Records/Certificates. LPA conducted 6 confidential and 1 attempt interviews between 7/13/22-7/15/22.

(See next page)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rosa Rodriguez	TELEPHONE: (916) 662-1458
LICENSING EVALUATOR NAME: Stephanie Lor	TELEPHONE: 530-513-4183
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 23-CR-20220708174547

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: 10/12/2022

NARRATIVE

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On 7/15/22, a walk through was completed and no hazardous items were observed in the home. In addition, C1, C2, and C3 did not have any information regarding hazardous items in the home. The resource parent denied the allegation and confirmed that there are no hazardous items accessible to the children. In addition, S1 indicated having no concerns with the care and supervision from the resource parents.

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

An exit interview was conducted with the Administrator . A copy of this report and the Appeal Rights will be emailed to the agency.

SUPERVISOR'S NAME: Rosa Rodriguez	TELEPHONE: (916) 662-1458
LICENSING EVALUATOR NAME: Stephanie Lor	TELEPHONE: 530-513-4183
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022

LIC9099 (FAS) - (06/04)

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