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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376100700
Report Date: 03/22/2022
Date Signed: 03/22/2022 04:02:24 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
03/03/2022 and conducted by Evaluator Adrian L Mangina
COMPLAINT CONTROL NUMBER: 51-CC-20220303163730
FACILITY NAME:SHAMOON, WARDYAH FAMILY CHILD CAREFACILITY NUMBER:
376100700
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 1DATE:
03/22/2022
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Shamoon WardyaTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Facility is operating over the capacity.
INVESTIGATION FINDINGS:
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On 3/22/22 at 3:30 pm Licensing Program Analyst (LPA) Adrian Mangina conducted an unannounced complaint visit for the complaint received on 3/3/22. The purpose of the visit is to deliver findings on the above referenced allegation. LPA met with Licensee Wardya Shamoon. Language Link Interpreter Mohammed #14200 and Interpreter Esraa #13578 provided translation. There was 1 child care.

It was alleged that Licensee was operating over capacity for the month of December and cared for as many as 12 children on December 6, 2021 during the hours of 2:30 PM and 5:00 PM. During the investigation LPA reviewed documents and conducted interviews which confirmed that Licensee was operating over capacity. LPA reviewed sign in sheets for the time in question, which showed that Licensee was caring for more children than the license allows. The allegation is valid because the preponderance of the evidence has been met, therefore, the above allegation is found to be SUBSTANTIATED.

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

DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022
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-20220303163730
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: 03/22/2022
NARRATIVE
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(LIC9099 page 2)

California Code of Regulations, (Title 22, Division 12, Chapter 1, Section102416.5(c), Staffing Ratio and Capacity.

See LIC9099-D for Type A deficiency cited.

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. A notice of site visit (LIC9213) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 51-CC-20220303163730
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: 03/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/23/2022
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 previously disenrolled 9 children effective 12/2/21. 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 December 2021 on at least three occasions, including 12/3/21, 12/6/21 and 12/16/21, Licensee cared for between 10 and 12 children between the hours of 3:00 PM and 5:30 PM which posed 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: 03/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3