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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 393621889
Report Date: 10/03/2023
Date Signed: 10/03/2023 10:53:44 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/03/2023 and conducted by Evaluator Erwin Tjhia
COMPLAINT CONTROL NUMBER: 53-CC-20230803165845
FACILITY NAME:KHAN, SHAZIAFACILITY NUMBER:
393621889
ADMINISTRATOR:KHAN, SHAZIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 263-9371
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:14CENSUS: 11DATE:
10/03/2023
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Shazia KhanTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Licensee shares child's private information with another parent
Licensee failed to seek medical care for a child with a high fever.
INVESTIGATION FINDINGS:
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According to the complainant, licensee (L1) shared private information of a daycare child to another parent. LPA investigated this allegation, conducted interviews and reviewed records. LPA learned that on 8/24/2022, licensee admitted to licensing that she needed a second opinion regarding the health status of a daycare child, and she shared private information with another parent who she had consulted for advice.

The complainant also alleged that L1 failed to seek medical care for a child with high fever. Licensee admitted that a parent had asked her to call 911 after she notified the parent of the child’s high fever. L1 explained that she did not feel it was necessary to call for paramedics, because she provided first aid, which reduced the child’s fever.

Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D. .
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023
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 5
Control Number 53-CC-20230803165845
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: KHAN, SHAZIA
FACILITY NUMBER: 393621889
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/04/2023
Section Cited
CCR
102423(a)(2)
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102423 Personal Rights (a) Each child receiving services...shall have certain rights that shall not be waived...by the licensee…These rights include..: (2) To receive safe, healthful, and comfortable accommodations...This requirement was not met as evidenced by:
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Licensee will send LPA a written statement stated that she would call the emergency response when requested by the parents.
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Licensee failed to notify emergency services though had been requested by the parents.
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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: Bettina Engelman
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 53-CC-20230803165845
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: KHAN, SHAZIA
FACILITY NUMBER: 393621889
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/18/2023
Section Cited
CCR
102423(a)(1)
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Each child receiving services from a family child care home shall have certain rights... These rights include, but are not limited to, the following:
(1) To be treated with dignity in his/her personal relationship with staff and other persons. This requirement was not met as evidenced by:
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Licensee will send LPA a written statement stating that Licensee will keep children’s private information confidential.
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LPA learned that on 8/24/2022, licensee admitted to licensing that she needed a second opinion regarding the health status of a daycare child, and she shared private information with another parent who she had consulted for advice.
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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: Bettina Engelman
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/03/2023 and conducted by Evaluator Erwin Tjhia
COMPLAINT CONTROL NUMBER: 53-CC-20230803165845

FACILITY NAME:KHAN, SHAZIAFACILITY NUMBER:
393621889
ADMINISTRATOR:KHAN, SHAZIAFACILITY TYPE:
810
ADDRESS:239 ORIOLE LANETELEPHONE:
(209) 263-9371
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:14CENSUS: 11DATE:
10/03/2023
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Shazia KhanTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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9
Licensee transported infants in vehicles without carseats.
Licensee does not live in the family child care home.
INVESTIGATION FINDINGS:
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According to the complainant, L1 transported infants in vehicles without car seats. Interview with L1 and staff revealed L1 always asked parent’s permission to transport their children in vehicles with age-appropriate car seats. L1 stated that she currently only transports older children with booster in her new car. Parents who were interviewed stated that they did not have any concerns regarding L1 transporting their children in her car.

It was also alleged that L1 did not live in the family childcare home. Interview with L1 and staff revealed that even though L1 has recently purchased another property, she is still living at the facility. L1 stated that she will rent out the new house as AirBnB. Interview with parents and staff revealed that L1 has been present at the facility during drop off or pick up. The parents also stated that they were not informed regarding any changes at the facility. Moreover, LPA also observed licensee to be present in the home during the inspection that was conducted on 08/10/2023.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. Based on the information obtained throughout the investigation, the above allegations are determined to be UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5