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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414003031
Report Date: 02/17/2022
Date Signed: 02/17/2022 04:29:41 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/13/2021 and conducted by Evaluator Luis Gomez
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20211213092927
FACILITY NAME:IHSD, INC-LAKEWOOD CDC (PS)FACILITY NUMBER:
414003031
ADMINISTRATOR:GHEITH, KIFAHFACILITY TYPE:
850
ADDRESS:65 TOWER ROADTELEPHONE:
(650) 578-3440
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY:48CENSUS: 17DATE:
02/17/2022
UNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Kifah Gheith TIME COMPLETED:
04:40 PM
ALLEGATION(S):
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Day care staff are not adequately supervising day care children.
INVESTIGATION FINDINGS:
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On 2/17/2022 at 1:05P.M., LPA Luis J. Gomez met with Director, Kifah Gheith. Purpose of the inspection was explained and was for an unannounced complaint investigation to report the investigation findings. Present was the director and 6 staff caring for 17 children. All children present were preschool age. All adults had their criminal record clearances on file. Facility was inspected with director for health and safety hazards.

During inspection, LPA interviewed director, staff, reviewed facility records and performed observations. At 3:00P.M., Based on record review and interviews, LPA confirmed facility was missing documentation of minor injury child sustained while in care in children's files. During inspection, Advisory Note: Technical Assistance (LIC9102) was issued.

During the course of this investigation, site observations were conducted on 12/14/2021, 2/8/2022 and 2/17/2022. A facility records review was also complete, which included the parent handbook, children’s files, children's roster and staff files. LPA conducted interviews with the director, sample of parents, staff, children and all involved parties. (REFER TO 809C FOR CONT.)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022
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 2
Control Number 05-CC-20211213092927
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: IHSD, INC-LAKEWOOD CDC (PS)
FACILITY NUMBER: 414003031
VISIT DATE: 02/17/2022
NARRATIVE
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(Page 2)

Based on interviews, observations and record review; LPA is unable to determine if staff are not adequately supervising day-care children. During inspection, LPA observed staff providing constant visual supervision of day-care children.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated.

This report will be kept in the Facility File and will be made available for Public Review upon request. Website for Forms and Regulations: www.ccld.ca.gov. This report and rights to comment have been discussed.

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2