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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005971
Report Date: 07/31/2025
Date Signed: 08/22/2025 08:47:17 AM

Document Has Been Signed on 08/22/2025 08:47 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CRP RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:KAIR IN HOME SOCIAL SERVICES, INCFACILITY NUMBER:
397005971
ADMINISTRATOR/
DIRECTOR:		IKE CHINAKA CHIDUMAMFACILITY TYPE:
430
ADDRESS:2105 W MARCH LANE, STE 2TELEPHONE:
(209) 954-0614
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY: 0CENSUS: DATE:
07/31/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:35 PM
MET WITH:Gurmeet RajsinghTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced case management inspection at the agency and met with Administrator Gurmeet Rajsingh, who assisted with the inspection.

LPA learned of a verbal altercation that occurred between Resource Parent (RP2 - see confidential names list dated 7/31/2025) and child in care (C2), the agency's failure to report the incident to CCL, and agency personnel conduct.

Based on interviews with RP2, the other Resource Parent (RP1), C2, and C2's County Social Worker (CSW), LPA was informed that C2 was getting tea in the kitchen at night, which was against the house rules. RP2 discovered C2 there and a verbal altercation ensued due to C2 breaking the rules. RP2 yelled at C2, and C2 yelled back at RP2. RP2 was unaware that RP1 granted C2 permission to get tea. C2 explained that RP2 also made threats towards C2. RP2 stated that they did not threaten C2, but stated that they will defend themselves if they need to against C2. RP1 reported the incident to C2's CSW and the agency. A mediation meeting was held with the Resource Parents, the child, the Agency Social worker, and other members of the child's team to preserve placement. RP2 apologized to C1 and the incident was resolved. LPA found that the agency did not report this incident to CCL as required.
NAME OF LICENSING PROGRAM MANAGER: Jodean Hall
NAME OF LICENSING PROGRAM ANALYST: Alyssa M Burgess
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/31/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 07/31/2025 04:35 PM - It Cannot Be Edited


Created By: Alyssa M Burgess On 07/23/2025 at 03:59 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: KAIR IN HOME SOCIAL SERVICES, INC
FACILITY NUMBER: 397005971

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/31/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/29/2025
Section Cited
ILS
88361(d)

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Reporting Requirements. A foster family agency shall make a report to the Department when any of the following events occur...

This requiement was not met as evidenced by:
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Administrator trained all ASWs on Reporting Requirements from the ILSV6, as well as she reviewed them herself. Administrator follows up with the ASWs every two weeks. No further action required. Repeat Civil Penalty assessed.
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Based on interviews and record review, the Agency failed to report an incident to CCL involving a Resource Parent having a verbal altercation with a child in care. This is a potential Health, Safety, or Personal Rights risk to children in care.
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Type B
08/29/2025
Section Cited
ILS88487.8(b)(2)

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Personal Rights. ...a Resource Family shall ensure that each child is accorded the following personal rights: To live in a safe, healthy, and comfortable home where they are treated with respect...

This requirement was not met as evidenced by:
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Agency will train the Resource Parent on personal rights, and how to manage negative child behaviors in a trauma-informed way, and in a professional manner. By POC due date, the training materials and certificate will be sent to CCL.
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Based on statements, the Resource Parent engaged a child in care in a verbal altercation and inappropriate power struggle, failing to meet this standard. This is a potential Health, Safety, or Personal Rights risk to children 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.
Jodean Hall
NAME OF LICENSING PROGRAM MANAGER:
Alyssa M Burgess
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/31/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/31/2025


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CRP RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: KAIR IN HOME SOCIAL SERVICES, INC
FACILITY NUMBER: 397005971
VISIT DATE: 07/31/2025
NARRATIVE
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Additionally, LPA was informed during an interview with a Resource Parent, that the CEO of the agency threatened to take their license away for reporting a complaint to CCL, and brought up a past complaint to them, asking them how that felt. The Resource Parent also reported the CEO yelled at them. In speaking with the CEO, he confirmed that he did threaten to take away their license, and that he yelled at the Resource Parent; that they were both yelling at each other.

On this date violations of the Foster Family Interim Licensing Standards, Version 6, Sections 88361(d) and 88487.8(b)(2) are being cited on the attached LIC 809-D. A repeat civil penalty is being assessed for violation of 88361(d).

An exit interview was conducted with Administrator and a copy of this report, confidential names list, and appeal rights were provided to her.
NAME OF LICENSING PROGRAM MANAGER: Jodean Hall
NAME OF LICENSING PROGRAM ANALYST: Alyssa M Burgess
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
LIC809 (FAS) - (06/04)
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