010209844-6-7-2022-02-CC-SJON-CGKMNS-20220722094602

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 010209844
Report Date: 06/07/2022
Date Signed: 06/07/2022 02:23:36 PM

Substantiated

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
06/06/2022 and conducted by Evaluator Christina Watts

PUBLIC

COMPLAINT CONTROL NUMBER: 02-CC-20220606152451

FACILITY NAME:	BLUESKIES FOR CHILDREN - ELLEN SHERWOOD NURS SCH		FACILITY NUMBER:	010209844
ADMINISTRATOR:	GARCIA, KAIYA SHEPARD		FACILITY TYPE:	850
ADDRESS:	3021 BROOKDALE AVENUE		TELEPHONE:	(510) 261-1077
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94602
CAPACITY:	54	CENSUS: 76	DATE:	06/07/2022
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Christa Edwards		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff engaged in a verbal altercation in the presence of children.

INVESTIGATION FINDINGS:

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On 06/07/2022 at 11:00 AM, Licensing Program Analysts (LPAs) Christina Watts and Ashley Curry conducted an unannounced complaint investigation. LPA's met with the Director Christa Edwards to discuss the above allegation. Present in care today were 76 children. The allegation was staff engaged in verbal altercation in the presence of children. The LPA's conducted interviews with staff and review facility records. During the course of the interviews, it was determined that the hostile confrontation occurred in the presence of children. This has caused the children to act out in a more aggressive manner and their behaviors have changed. Based on LPA's interviews the preponderance of evidence standard has been met. Therefore the above allegation is found to be SUBSTANTIATED.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina Watts	TELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 02-CC-20220606152451

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
	VISIT DATE: 06/07/2022

NARRATIVE

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A Type A citation is being issued today. LPA Watts informed Director Christa Edwards that this report dated 06/07/2022 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there are immediate risk to the health, safety, or personal rights of children in care. LPA Watts informed Director, Christa Edwards to provide a copy of this licensing report dated 06/07/2022 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed acknowledgement of Receipt of Licensing Report (LIC 9224) or other written statement, must be placed in child's file for verification.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, appeal rights were given, and copy of this report was reviewed with Director Christa Edwards,

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina Watts	TELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

LIC9099 (FAS) - (06/04)

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Control Number 02-CC-20220606152451

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: 06/07/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed Type A 06/08/2022 Section Cited CCR 101223(a)(1)	1 2 3 4 5 6 7	101223Personal Rights(a)The licensee shall ensure that each child is accorded the following personal rights:(1)To be accorded dignity in his/her personal relationships with staff.. This requirement was not met as evidence by:	1 2 3 4 5 6 7	By 06/08/2022, Director will submit written documentation of how incident could have been handled without violating the children's personal rights. By 06/21/2022, the facility must conduct all staff training on personal rights. Director will submit written conformation to LPA.
	8 9 10 11 12 13 14	Based on interviews and record review, the Director violated the children's rights by having an verbal altercation with another staff member in front of children causing the children's behavior to change, which poses an immediate risk to the health, safety, and personal rights of children.	8 9 10 11 12 13 14
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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: Sherelle Johnson	TELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina Watts	TELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

LIC9099 (FAS) - (06/04)

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