<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013412359
Report Date: 09/11/2020
Date Signed: 09/11/2020 02:13:58 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
09/02/2020 and conducted by Evaluator Jabari Wilson
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20200902163621
FACILITY NAME:DAVIS STREET AT JEFFERSONFACILITY NUMBER:
013412359
ADMINISTRATOR:PATTEN, MARYFACILITY TYPE:
840
ADDRESS:14300 BANCROFT AVENUETELEPHONE:
(510) 483-3637
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY:45CENSUS: 10DATE:
09/11/2020
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Sheila Langham & Guyla Lopez, DirectorsTIME COMPLETED:
02:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Other - Uncleared staff personnel on site.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
09/10/2020, at approximately 11:00 AM LPA Jabari Wilson & LPM Chandra Charles conducted an Unannounced Complaint Investigation at Davis Street -Jefferson day-care School Age Program. LPA & LPM met with site Directors Sheila Langham & Guyla Lopez.
Present during the inspection were Teachers Lacy McHenry, Marina Lopez, and 10 School Age children.

LPM advised the Directors a Complaint has been filed against the facility license. The allegation falls under the Complaint category of "Other." During the course of the investigation interviews were conducted, a copy of the day-care facility Personnel Report was obtained which, was cross referenced against the Community Care licensing Department association report.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Jabari WilsonTELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2020
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-20200902163621
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: DAVIS STREET AT JEFFERSON
FACILITY NUMBER: 013412359
VISIT DATE: 09/11/2020
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Based on the investigation conducted, Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove to the alleged violation did or did not occur, therefore, the allegation is unsubstantiated.

Directors were advised before any hired personnel staff or any Administration staff personnel is moved over to the day-care facility, everyone needs a fingerprint clearance.

Exit interview conducted with the Site directors Sheila Langham & Guyla Lopez, appeals were provided.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Jabari WilsonTELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2