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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073409274
Report Date: 04/15/2025
Date Signed: 04/30/2025 01:36:06 PM

Unsubstantiated


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
03/21/2025 and conducted by Evaluator Cherie Acosta
COMPLAINT CONTROL NUMBER: 02-CC-20250321085445
FACILITY NAME:CHAUHAN, SHABANA PARVEENFACILITY NUMBER:
073409274
ADMINISTRATOR:CHAUHAN, SHABANA PARVEENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 286-4210
CITY:OAKLEYSTATE: CAZIP CODE:
94561
CAPACITY:14CENSUS: 6DATE:
04/15/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Shabana Parveen ChauhanTIME COMPLETED:
11:25 AM
ALLEGATION(S):
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Licensee did not report injury to authorized representative.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Cherie Acosta and Jamel Maiwandi conducted an unannounced visit to investigate the above allegation.

During the investigation LPAs conducted interviews and reviewed documents. Although child in care did have a scratch, LPAs were unable to prove if the child received the scratch while in care.
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 deemed unsubstantiated.
Notice of Site Visit was provided and must be posted for 30 days.
Exit interview and report reviewed with Shabana Parveen Chauhan
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
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
03/21/2025 and conducted by Evaluator Cherie Acosta
COMPLAINT CONTROL NUMBER: 02-CC-20250321085445

FACILITY NAME:CHAUHAN, SHABANA PARVEENFACILITY NUMBER:
073409274
ADMINISTRATOR:CHAUHAN, SHABANA PARVEENFACILITY TYPE:
810
ADDRESS:534 AVANTI WAYTELEPHONE:
(415) 286-4210
CITY:OAKLEYSTATE: CAZIP CODE:
94561
CAPACITY:9CENSUS: DATE:
04/15/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Shabana Parveen ChauhanTIME COMPLETED:
11:25 AM
ALLEGATION(S):
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Licensee did not keep hazardous items inaccessible to children
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Cherie Acosta and Jamel Maiwandi conducted an unannounced visit to investigate the above allegation.

Licensee admitted that scissors were left in the backyard and were accessible to children in care. The backyard is on limits to children.

Based on interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is to be substantiated.

Notice of Site Visit was provided and must be posted for 30 days.
Exit interview and report reviewed with Shabana Parveen Chauhan
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 02-CC-20250321085445
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: CHAUHAN, SHABANA PARVEEN
FACILITY NUMBER: 073409274
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/29/2025
Section Cited
CCR
102417(g)(4)
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Operation of a Family Child Care Home.The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to:Poisons, detergents, cleaning compounds, medicines,
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Licensee shall review the regulation and submit a letter to CCL by 4/29/25 ensuring she understand the regulation and shall remain in compliance.
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firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.This requirement was not met as evidenced by:scissors were accessible to children in care which poses a potential risk to the health and safety of children in care.
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• Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected
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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: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3