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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 010213008
Report Date: 10/10/2019
Date Signed: 10/10/2019 04:11:50 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 STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/27/2019 and conducted by Evaluator Briana Plumboy
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20190927091534
FACILITY NAME:YMCA OF THE EAST BAY Y-KIDS MARSHALLFACILITY NUMBER:
010213008
ADMINISTRATOR:CINDY AGERSFACILITY TYPE:
840
ADDRESS:20111 MARSHALL ST.TELEPHONE:
(510) 581-4996
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY:60CENSUS: 8DATE:
10/10/2019
UNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Latashia WilliamsTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Personal Rights- Staff speaks inappropriately towards daycare children while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Briana Plumboy met with Acting Director Latashia Williams for the purpose of an UNANNOUNCED COMPLAINT INSPECTION. Present for this inspection was 8 school age children as well as 3 staff.
The allegation 2 staff spoke inappropriatly to children in care has been SUBSTANTIATED. Based on LPAs interviews, children in care were spoken to in a tone of voice which was intimidating as well as 1 staff called children in care innapropiate names. The preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Title 22, Division 12, Chapter 1, Section 101223(a)(3) is being cited on the attached LIC. 9099D. A notice of site visit was given and must remain posted for 30 days.The attached Type A deficiency is cited today.

See 9099C and 9099D for continuance
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019
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 4
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 STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/27/2019 and conducted by Evaluator Briana Plumboy
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20190927091534

FACILITY NAME:YMCA OF THE EAST BAY Y-KIDS MARSHALLFACILITY NUMBER:
010213008
ADMINISTRATOR:CINDY AGERSFACILITY TYPE:
840
ADDRESS:20111 MARSHALL ST.TELEPHONE:
(510) 581-4996
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY:60CENSUS: 8DATE:
10/10/2019
UNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Latashia WilliamsTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
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7
8
9
Personal Rights- Staff inappropriately handles daycare children
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Briana Plumboy met with Acting Director Latashia Williams for the purpose of an UNANNOUNCED COMPLAINT INSPECTION. Present for this inspection was 8 school age children as well as 3 staff.

The allegation staff inappropriately handles daycare children in care was investigated. Based on interviews conducted, the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore, the allegation is UNSUBSTANTIATED.
A notice of site visit was given and must remain posted for 30 days.
Appeal Rights were given and discussed. An exit interview was conducted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019
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 4
Control Number 52-CC-20190927091534
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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: YMCA OF THE EAST BAY Y-KIDS MARSHALL
FACILITY NUMBER: 010213008
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/10/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/11/2019
Section Cited
CCR
101223(a)(3)
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Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights.
(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature.
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POC: The facility has taken action against the 2 staff members. Current staff have taken measures to review children's personal rights so they are not violated while in care.
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This requirement was not met as evidenced by interview: Director was observed yelling at children by a parent and multiple witnesses observed a staff using inappropriat language toward children in care. CCL regulations state that children have personal rights, and those rights include to be treated with dignity in his/her personal relationship with staff and other persons, and to be free of mental abuse. This poses an immediate health risk to the Personal Rights of children in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
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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: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 52-CC-20190927091534
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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: YMCA OF THE EAST BAY Y-KIDS MARSHALL
FACILITY NUMBER: 010213008
VISIT DATE: 10/10/2019
NARRATIVE
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Upon receipt, licensee shall post for 30 days and provide copies of this licensing report to parent/guardians of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 Acknowledgement of Receipt of Licensing Reports should be signed by guardians and placed in each child’s file. Appeal Rights were given and discussed. An exit interview was conducted.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019
LIC9099 (FAS) - (06/04)
Page: 4 of 4