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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 394501061
Report Date: 08/01/2024
Date Signed: 08/01/2024 01:39:37 PM

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
07/08/2024 and conducted by Evaluator Erwin Tjhia
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20240708143151
FACILITY NAME:GIRI, NIRMALAFACILITY NUMBER:
394501061
ADMINISTRATOR:GIRI, NIRMALAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(317) 480-3184
CITY:LATHROPSTATE: CAZIP CODE:
95330
CAPACITY:14CENSUS: 16DATE:
08/01/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Nirmala GiriTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Facility is operating out of ratio
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tjhia met with Licensee, Nirmala Giri to deliver findings of the complaint investigation regarding the above allegations.

It was alleged that Facility is operating out of ratio. During arrival at the facility today, LPA observed 14 children supervised by licensee and two staff. Licensee stated that her 7 years old daughter was also present at the facility. About 15 minutes later, LPA observed another child was dropped off at the facility. Licensee stated that child was her daughter’s friend, and they will be in the off-limit area. Licensee stated including her daughter and the friend, there were 16 children at the facility.

Based on the information obtained during the investigation the evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. The following Title 22 Deficiency is being cited on the subsequent 9099-D page. Upon receipt of Type A citations, Licensee shall post and provide copies of the LIC 9099-D for parents/guardians of children in care and for parents/guardians of newly enrolled children for the next 12 months. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Appeal Rights were provided, and LPA posted a Notice of Site Visit which must remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024
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 2
Control Number 53-CC-20240708143151
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: GIRI, NIRMALA
FACILITY NUMBER: 394501061
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/01/2024
Section Cited
CCR
102416.5(f)
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102416.5(f) The total licensed capacity for a Large Family Child Care Home shall not exceed fourteen children.
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Licensee stated that she did not know that her 7 years old daughter and friends will be counted into ratio when they were at the Off-limit area. Licensee stated that she will make sure to have her daughter and any visiting friend included in the facility’s ratio in the future .
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This requirement was not met as the evidenced by: Based on LPA’s observation, the licensee did not comply with the section cited above as LPA observed more than 14 children were in care at the facility which poses an immediate health, safety or personal rights risk to persons in care.
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LPA will conduct follow up visit to verify compliance,
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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: Karyn Guerra
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2