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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 010209844
Report Date: 01/27/2022
Date Signed: 01/27/2022 02:21:59 PM



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
01/18/2022 and conducted by Evaluator Tasha Hackett-Alexander
COMPLAINT CONTROL NUMBER: 02-CC-20220118100759
FACILITY NAME:BLUESKIES FOR CHILDREN - ELLEN SHERWOOD NURS SCHFACILITY NUMBER:
010209844
ADMINISTRATOR:GARCIA, KAIYA SHEPARDFACILITY TYPE:
850
ADDRESS:3021 BROOKDALE AVENUETELEPHONE:
(510) 261-1077
CITY:OAKLANDSTATE: CAZIP CODE:
94602
CAPACITY:54CENSUS: 75DATE:
01/27/2022
UNANNOUNCEDTIME BEGAN:
12:49 PM
MET WITH:KRISTA EDWARDSTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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PERSONAL RIGHTS- Facility not following COVID-19 guidelines
INVESTIGATION FINDINGS:
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12:00PM LICENSING PROGRAM ANALYST TASHA ALEXANDER MET WITH CENTER DIRECTOR KRISTA EDWARDS IN REGARDS TO THE ABOVE COMPLAINT ALLEGATION. A RISK ASSESSMENT WAS CONDUCTED AT THE FRONT DOOR OF THE FACILITY. THERE HAS BEEN SEVERAL RECENT POSITIVE COVID-19 CASES REPORTED TODAY. DUE TO THE RECENT POSITIVE REPORTS THIS INVESTIGATION WAS CONDUCTED AT THE FRONT DOOR OF THE FACILITY WITH THE DIRECTOR.

PER DIRECTOR THERE ARE 75 CHILDREN PRESENT TODAY ALONG WITH 30 STAFF. TODAY THE COVID GUIDELINES, REPORTING REQUIREMENTS, EXPOSURES, POSITIVE CASES AND ISOLATION PROCEDURES FOR THE FACILITY WERE DISCUSSED. DURING CONVERSATION AND A RESEARCH OF CURRENT CDC AND LOCAL HEALTH DEPARTMENT GUIDELINES, IT WAS DISCOVERED THAT THE FACILITY IS NOT FULLY FOLLOWING THE CURRENT GUIDANCE ON HOW TO KEEP CHILDREN AND STAFF SAFE WHEN EXPOSED TO COVID-19 OR WHEN TESTING POSITIVE.

BASED ON LPAs OBSERVATIONS AND INTERVIEWS WHICH WERE CONDUCTED AND RECORD REVIEWS, THE PREPONDERANCE OF EVIDENCE STANDARD HAS BEEN MET, THEREFORE THE ABOVE ALLEGATION IS FOUND TO BE SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12 & Chapter number 1), ARE BEING CITED ON THE ATTACHED LIC. 9099D.”
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2022
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 02-CC-20220118100759
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: BLUESKIES FOR CHILDREN - ELLEN SHERWOOD NURS SCH
FACILITY NUMBER: 010209844
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/27/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/10/2022
Section Cited
CCR
101223(a)(2)
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101223 Personal Rights
a) The licensee shall ensure that each child is accorded the following personal rights:
(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
REQUIREMENT WAS NOT MET;
FACILITY HAS NOT BEEN FOLLOWING THE CURRENT CDC GUIDELINES FOR POSITIVE OR EXPOSURE GUIDANCE ON HOW TO KEEP CHILDREN SAFE.
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DIRECTOR WILL READ THE CURRENT CDC GUIDELINES, ALAMEDA HEALTH DEPARTMENT GUIDELINES FOR COVID-19 AS WELL AS COMMUNITY CARE LICENSING'S WEBSITE FOR INFORMATION.
DIRECTOR WILL SUBMIT A WRITTEN STATEMENT ACKNOWLEDGING THE ABOVE AND THE IMPORTANCE OF KEEPING CURRENT ON THE GUIDELINES FOR THE SAFETY OF THE CHILDREN AND STAFF IN THE FACILITY. TO BE SUBMITTED TO COMMUNITY CARE LICENSING BY 2/10/22
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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.
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2022
LIC9099 (FAS) - (06/04)
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