013412358-9-19-2022-52-CC-CCHS-CJY2GU-20221006172342

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 013412358
Report Date: 09/19/2022
Date Signed: 09/19/2022 11:34:21 AM

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 STE 1102
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/06/2022 and conducted by Evaluator Sabina Dodoo

PUBLIC

COMPLAINT CONTROL NUMBER: 52-CC-20220906120646

FACILITY NAME:	DAVIS STREET AT JEFFERSON		FACILITY NUMBER:	013412358
ADMINISTRATOR:	LANGHAM, SHEILA		FACILITY TYPE:	850
ADDRESS:	14300 BANCROFT AVENUE		TELEPHONE:	(510) 483-3637
CITY:	SAN LEANDRO	STATE: CA	ZIP CODE:	94578
CAPACITY:	41	CENSUS: 9	DATE:	09/19/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Sheila Langham		TIME COMPLETED:	11:40 AM

ALLEGATION(S):

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Other- Daycare child sustained multiple injuries while attending daycare.

INVESTIGATION FINDINGS:

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On Monday 9/19/22 at approximately 9am, Licensing Program Analyst (LPA) Sabina Dodoo and Licensing Program Manager(LPM) Chandra Charles, conducted an Unannounced Complaint Inspection at Davis Street at Jefferson. LPA Dodoo and LPM Charles met with Director Sheila Langham. Present during the inspection were the Director and 2 teachers who are all fingerprint cleared. The census was 9 children.

The purpose of this visit is to deliver the findings in regards to a complaint filed against the facility. The allegation of the complaint was daycare child sustained multiple injuries while attending daycare. Based on observations, interviews, and evidence the preponderance of evidence standard has been met. Therefore the above allegation(s) is found to be SUBSTANTIATED. Investigation did not reveal that there was a lack of supervision. This was an unfortunate slip and fall accident. A Techical Assistance advisory was given. (Please see LIC 9102 for details). Exit interview was conducted with Director Sheila Langham. A copy of this report and a copy of Appeal Rights was provided.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Sabina Dodoo	TELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2022

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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