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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376100700
Report Date: 02/08/2022
Date Signed: 02/08/2022 03:53:47 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/20/2021 and conducted by Evaluator Adrian L Mangina
PUBLIC
COMPLAINT CONTROL NUMBER: 51-CC-20211220150725
FACILITY NAME:SHAMOON, WARDYAH FAMILY CHILD CAREFACILITY NUMBER:
376100700
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: DATE:
02/08/2022
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Wardya ShamoonTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility is operating overcapacity.
INVESTIGATION FINDINGS:
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On 2/8/22 at 3:30 PM Licensing Program Analyst (LPA) Adrian Mangina conducted an unannounced complaint visit for the complaint received on 11/22/21 for the purpose of delivering findings on the above referenced allegation. LPA met with Licensee Wardya Shamoon. Also in the home was LIcensee's adult Daughter Maryam Galo who provded translation. There were no children in care.

During the investigation LPA reviewed documents and conducted interviews which confirmed that Licensee was operating over capacity. The allegation is valid because the preponderance of the evidence has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12, Chapter 1, Section 102416.5(c) the deficiency is being cited on the attached LIC 9099D. allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12, Chapter

(continued ON LIC9099 page 2)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022
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
Control Number 51-CC-20211220150725
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: SHAMOON, WARDYAH FAMILY CHILD CARE
FACILITY NUMBER: 376100700
VISIT DATE: 02/08/2022
NARRATIVE
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LIC9099 page 2)

An exit interview was conducted with the Licensee. The Licensee was provided a copy of this report (LIC 9099). Upon receipt of this report, licensee shall post and provide copies of this licensing report to parents /guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide Acknowledgement of Receipt of Licensing Reports (LIC 9224) to the parent/guardian of for each child in care for signature acknowledging receipt of copy of this report. THIS REPORT MUST BE FILED IN FACILITY FILE AND MADE AVAILABLE FOR PUBLIC REVIEW FOR 3 YEARS.
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 51-CC-20211220150725
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: SHAMOON, WARDYAH FAMILY CHILD CARE
FACILITY NUMBER: 376100700
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/09/2022
Section Cited
CCR
102416.5(c)
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Staffing Ratio and Capacity: The total licensed capacity for a Small Family Child Care Home shall not exceed eight children.

This requirement was not met as evidenced by:
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Licensee states they have disenrolled 1 child effective 11/2/21, 1 child11/30/22. 7 children12/22/21 and 1 child 12/30/21. Licensee has provided LPA with a current schedule that shows licensee cares for no more than 8 children at once. Licensee states that in future will abide by all ratio and capacity requirements.
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Based on information received during interviews and record review, during the month of October 2021 on at least three occasions, including 10/4/21, 10/14/21 and 10/29/21, Licensee cared for between 10 and 13 children between the hours of 3:00 PM and 5:30 PM which poses an immediate health and safety 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.
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3