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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013411214
Report Date: 10/20/2020
Date Signed: 10/20/2020 01:35:15 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
10/15/2020 and conducted by Evaluator Briana Plumboy
COMPLAINT CONTROL NUMBER: 52-CC-20201015125320
FACILITY NAME:KIDANGO-GLEN BERRY CHILD DEVELOPMENT CENTERFACILITY NUMBER:
013411214
ADMINISTRATOR:DONUELL LILLYFACILITY TYPE:
850
ADDRESS:625 BERRY AVENUETELEPHONE:
(510) 907-1542
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY:32CENSUS: 9DATE:
10/20/2020
UNANNOUNCEDTIME BEGAN:
12:48 PM
MET WITH:Arlene VigarsTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Other- Day care child has a communicable disease and is still attending day care
INVESTIGATION FINDINGS:
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On 10/20/20 at 12:48pm, Licensing Program Analysts (LPAs) Sidney Cortez and Briana Plumboy met with Teacher Arlene Vigars. for the purpose of an UNANNOUNCED COMPLAINT INSPECTION. Present for this inspection was 3 fingerprint clear staff and 9 preschool age children.

The allegation there is a daycare child in care who has a communicable disease has been SUBSTANTIATED. Based on LPAs interviews and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Title 22, Division 12, Chapter 1, Section 101226.1(a) is being cited on the attached LIC. 9099D.
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.
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: 10/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2020
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 52-CC-20201015125320
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: KIDANGO-GLEN BERRY CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 013411214
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/20/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/30/2020
Section Cited
CCR
101226.1(a)
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Daily Inspection for Illness
(a) The licensee shall be responsible for ensuring that children with obvious symptoms of illness including, but not limited to, fever or vomiting, are not accepted.
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On or before 10/30/20, a doctors clearance note must be received by the Child Care Center prior to C1 returning to care at the center.
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This requirement was not met as evidenced by:
Based on interview and record review, child C1 was present at the child care center while having a communicable disease which poses a potential health and safety risk to 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: 10/20/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2