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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 010205830
Report Date: 11/17/2023
Date Signed: 11/17/2023 04:58:13 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/19/2023 and conducted by Evaluator Diana Campos
COMPLAINT CONTROL NUMBER: 02-CC-20230919083536
FACILITY NAME:AGNES MEMORIALFACILITY NUMBER:
010205830
ADMINISTRATOR:SANDRA PHELPSFACILITY TYPE:
850
ADDRESS:2372 INTERNATIONAL BLVDTELEPHONE:
(510) 533-1101
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY:24CENSUS: 10DATE:
11/17/2023
UNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Sandra PhelpsTIME COMPLETED:
05:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff denied child's authorized represenatative entry into the facility
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
 LPA Diana Campos met with Center Director Sandra Phelps for a complaint investigation regarding the above allegation. Present were 2 staff and 10 preschool children in care. It was alleged that staff denied child's authorized representative entry into the facility. During the course of the investigation, interviews were conducted. Per interviews conducted an incident occurred when a woman attempted to pick up a child from the center who was not listed as the child's authorized representative. Interviews also revealed that the adult woman was behaving beligerant and aggressive with staff. A review of records revealed that some children enrolled were missing the emergency information cards which contains the list of authorized represantatives. Based on the investigative findings, LPA was unable to determine whether or not staff denied child's authorized representative entry into the facility. Although the allegation 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.

A Notice of Site Visit was provided and must remain mposted for 30 days.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana CamposTELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/19/2023 and conducted by Evaluator Diana Campos
COMPLAINT CONTROL NUMBER: 02-CC-20230919083536

FACILITY NAME:AGNES MEMORIALFACILITY NUMBER:
010205830
ADMINISTRATOR:SANDRA PHELPSFACILITY TYPE:
850
ADDRESS:2372 INTERNATIONAL BLVDTELEPHONE:
(510) 533-1101
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY:24CENSUS: 10DATE:
11/17/2023
UNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Sandra PhelpsTIME COMPLETED:
05:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not following proper sign in/out procedures.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LPA Diana Campos met with Center Director Sandra Phelps for a complaint investigation regarding the above allegation. Present were 2 staff and 10 preschool children in care. It was alleged that staff are not following proper sign in/out procedures. During the course of the investigation, interviews were conducted and records reviewed. Interviews revealed that most children are signed in/out by the staff that conducts the pick up/drop off of children in care. Per record review on 9/26/2023 a copy of sign in out log was made available to LPA, but no other logs were available for previous months. Based on the investigative findings, there was no evidence to determine whether or not staff are not following proper sign in/out procedures. Although the allegation 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.

A Notice of Site Visit was provided and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana CamposTELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 2