397005971-1-27-2023-23-CR-RROZ-CNPPZ5-20230203104458

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 397005971
Report Date: 01/27/2023
Date Signed: 01/27/2023 04:03:13 PM

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
11/01/2022 and conducted by Evaluator Stephanie Lor

PUBLIC

COMPLAINT CONTROL NUMBER: 23-CR-20221101103923

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:	28	CENSUS:	DATE:	01/27/2023
		UNANNOUNCED	TIME BEGAN:	12:44 PM
MET WITH:	Gurmeet Singh, Administrator		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Resource parent did not prevent a physical altercation between youth

INVESTIGATION FINDINGS:

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On 1/27/23 , 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 and the resource home on 11/8/22. No deficiencies were cited at that time. LPA obtained copies of background clearance, home study, home sketch, training certificates, intake forms, Health and Education Passport, Needs and Services Plan, and incident report. LPA conducted confidential interviews between November 7-29, 2022.

(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: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

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-20221101103923

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: 01/27/2023

NARRATIVE

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Based on the interviews conducted, it was reported that Resource Parent stopped the fight as soon as it occurred in the home. Incident report indicated that the Resource Parent notified S2 right away and S2 showed up at the home to de-escalate the situation. Even though the incident took place, the resource parent took immediate action and took care of the situation. In addition, it was reported that Resource Parent separated the youth and they are no longer sharing room together.

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 was provided 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: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

LIC9099 (FAS) - (06/04)

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