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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013414662
Report Date: 11/23/2020
Date Signed: 11/23/2020 12:17:08 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, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/20/2020 and conducted by Evaluator Brittany Newton
COMPLAINT CONTROL NUMBER: 02-CC-20201120153819
FACILITY NAME:WADE, NATASHIAFACILITY NUMBER:
013414662
ADMINISTRATOR:WADE, NATASHIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 423-1509
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY:14CENSUS: 4DATE:
11/23/2020
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Natashia WadeTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Licensee gave day care children expired food
Licensee didn't provide day care child adequate supervision resulting in injury
INVESTIGATION FINDINGS:
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On 11/23/2020, Licensing Program Analyst (LPA) Brittany Newton made an unannounced phone call to the above licensee due to COVID-19 restrictions for the purpose of opening a complaint investigation. Present at the home was 3 preschoolers and one school aged child. LPA Newton conducted a record review and interviewed the licensee. Interview revealed that the licensee did give a child a expired pastry. Interview additionally revealed that the licensee's child was playing with another day care child and pulled the day care child on a rug which resulted in the child getting a rug burn. Therefore, the above allegations are found to be Substantiated. California Code of Regulations, (Title 22, Division 12) is being cited on the attached LIC9099D.

Exit interview conducted. Facility was emailed a copy of their appeal rights, this report, and a Notice of site visit. Signature not obtained due to COVID-19 restrictions, an emailed response from the licensee confirms confirmation of receieving this report.
Substantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Brittany NewtonTELEPHONE: (510) 622-2594
LICENSING EVALUATOR SIGNATURE:

DATE: 11/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2020
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 02-CC-20201120153819
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: WADE, NATASHIA
FACILITY NUMBER: 013414662
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/23/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/27/2020
Section Cited
CCR
102423(a)(2)
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102423(a)(2) Personal rights. (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement was not met as evidenced by:
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Licensee agrees to submit a letter to LPA Newton stating she will not give expired food to children by 11/27/2020.
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Based on interviews conducted a day care child was given an expired pastry which poses a potential Health, Safety, or Personal Rights risk to children in care.
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Type B
11/27/2020
Section Cited
CCR
102417(a)
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102417(a) Operation of a Family Child Care Home. The licensee shall be present in the home and shall ensure that children in care are supervised at all times. This requirement was not met as evidenced by:
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Licensee agrees to submit a letter to LPA Newton stating she will ensure supervision of playing amongst children at all times by 11/27/2020.
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Based on interviews conducted the licensees child and another day-care child were playing, the licensee's child pulled the other child on the rug resulting in a rug burn which poses a potential Health, Safety, or personal rights risk to children in care.
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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: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Brittany NewtonTELEPHONE: (510) 622-2594
LICENSING EVALUATOR SIGNATURE:

DATE: 11/23/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2