010215003-3-28-2023-02-CC-LDYN-CRDN68-20230430101043

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 010215003
Report Date: 03/28/2023
Date Signed: 03/28/2023 12:21:14 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
02/09/2023 and conducted by Evaluator Phyllis Dyer

PUBLIC

COMPLAINT CONTROL NUMBER: 02-CC-20230209162955

FACILITY NAME:	OAKLAND HEAD START - ARROYO VIEJO PARK		FACILITY NUMBER:	010215003
ADMINISTRATOR:	ORURUO, VIVIAN		FACILITY TYPE:	850
ADDRESS:	7701 KRAUSE AVENUE		TELEPHONE:	(510) 615-5757
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94605
CAPACITY:	16	CENSUS: 6	DATE:	03/28/2023
		UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Angelita Harris		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

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Kleenex was placed in day-care child's mouth and ears.

INVESTIGATION FINDINGS:

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Licensing Program Analyst Lisa Dyer met with Director Angelita Harris regarding the above allegation of Kleenex was placed in day-care child’s mouth and ears. Present today at the facility is the director, 2 teachers, and 6 day-care children. Interviews disclosed that during nap time a child was resting. A Staff member noticed that this child was playing with tissue. When a second Staff member came from lunch, they were told by the first Staff member that the child was playing with tissue. When the second staff member went to the child, they immediately noticed that the child had something in their mouth. This second Staff member told the child to open their mouth, and saw that the child had Kleenex in their mouth. This second staff member asked the child to take out the Kleenex, and they did. Therefore, this allegation is Substantiated.
Based on the LPA's observations and interviews which were conducted and record review(s), 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), are being cited on the attached LIC 9099D and must be corrected by the due date.
Exit interview conducted. Appeal rights were given/discussed. Notice of Site visit must be posted for 30 days.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Phyllis Dyer	TELEPHONE: (510) 725-7006
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

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-20230209162955

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: OAKLAND HEAD START - ARROYO VIEJO PARK	FACILITY NUMBER: 010215003
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/28/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/12/2023 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1).	1 2 3 4 5 6 7	Director will need to provide a written plan of action to CCL detailing how they will ensure that children are actively supervised at all times.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by interview and record review. Child had Kleenex in his mouth as he was laying down at nap. This poses a potential health risk to the health and safety of children in care.	8 9 10 11 12 13 14	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.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Phyllis Dyer	TELEPHONE: (510) 725-7006
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

LIC9099 (FAS) - (06/04)

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