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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015700612
Report Date: 09/19/2024
Date Signed: 09/19/2024 10:54:46 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/12/2024 and conducted by Evaluator Michael Mathew
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20240812190231
FACILITY NAME:LILY OF THE VALLEY EARLY EDUCATION & PRESCHOOLFACILITY NUMBER:
015700612
ADMINISTRATOR:KHAN, ABADATFACILITY TYPE:
830
ADDRESS:348 NORTH CANYONS PARKWAYTELEPHONE:
(408) 431-9226
CITY:LIVERMORESTATE: CAZIP CODE:
94551
CAPACITY:51CENSUS: 12DATE:
09/19/2024
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Abadat KhanTIME COMPLETED:
11:10 AM
ALLEGATION(S):
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Facility is operating out of ratio
INVESTIGATION FINDINGS:
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On September 19,2024 at, 8:30 AM Licensing Program Analyst (LPA) Michael Mathew conducted an unannounced inspection to conclude a complaint investigation LPA met with Director Abadat Khan and advised her the purpose of the inspection. Director provided LPA a tour of the facility inside and out. There were 12 children and 4 staff in care at the time of the inspection.

Allegation: Facility is operating out of ratio Based on LPA interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation of the Facility is operating out of ratio is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12, Chapter 1, Article 06, Section: 101416.5(b) Teacher-Infant Ratio, are being cited on the attached LIC 9099D.
A notice of site visit and appeal rights were given. Exit interview conducted and report was reviewed with Director Abadat Khan
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Michael Mathew
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 52-CC-20240812190231
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: LILY OF THE VALLEY EARLY EDUCATION & PRESCHOOL
FACILITY NUMBER: 015700612
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/26/2024
Section Cited
CCR
101416.5(b)
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101416.5(b) Teacher-infant Ratio: There shall be a ratio of one teacher for every four infants in attendance.

This requirement is not met as evidenced by:
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Director agreed to sent LPA a letter on how facility will keep ratio at the facility by end of day 9/26/24
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Based on interviews with staff, the facility did not comply with the section cited above as the facility operated out of ratio which poses a potential health, safety or personal rights risk to persons 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.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Michael Mathew
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5