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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013417788
Report Date: 02/10/2026
Date Signed: 02/10/2026 04:23:30 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/25/2025 and conducted by Evaluator Paulita De La Cruz
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20251125133454
FACILITY NAME:NORTHERN LIGHT SCHOOLFACILITY NUMBER:
013417788
ADMINISTRATOR:SHERIN AMEERDEENFACILITY TYPE:
850
ADDRESS:3710 DORISA AVENUETELEPHONE:
(510) 957-0570
CITY:OAKLANDSTATE: CAZIP CODE:
94605
CAPACITY:30CENSUS: 11DATE:
02/10/2026
UNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:MARYAM NAZARITIME COMPLETED:
04:40 PM
ALLEGATION(S):
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Record Keeping - Staff allows unvaccinated children to attend daycare
INVESTIGATION FINDINGS:
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Today, 2/10/2026 at approximately 3:10 PM, Licensing Program Analystst (LPA) Paulita De La Cruz and Indira Loza, met with teacher in charge, Maryam Nazari, for an unnanounced Complaint Investigation. There are 11 children and 2 teachers present during this visit.

During the course of this investigation, LPA De La Cruz found at least 2 children's files lacking immunization records. Based on staff interviews and children's records review, the preponderance of evidence standard has been met. Therefore the above allegation is Substantiated. Title 22, California Code of Regulations Child's Records 101221(a), is being cited on the attached LIC 9099-D.

An exit interview was conducted with Ms. Nazari and copy of this rerport and the Notice of Site Visit were provided. Appeal Rights was also provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Paulita De La Cruz
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2026
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 02-CC-20251125133454
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: NORTHERN LIGHT SCHOOL
FACILITY NUMBER: 013417788
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/10/2026
Section Cited
CCR
101221(a)
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Child's Records
(a) A separate, complete and current record for each child is maintained in the child care center.

This requirement is not met as evidenced by the lack of immunization records in the children's files, which poses a potential Health, Safety, or Personal Rights risk to children in care.
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Immunization records are not in file for children C-1 and C-2 listed on LIC 811 provided today.

The immunization records have been submitted and in the chilren's files. This deficiency has been cleared.
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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: Mayla Mendoza
LICENSING EVALUATOR NAME: Paulita De La Cruz
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2