013415659-5-31-2024-02-CC-MMEA-D6FW5A-20240621165847

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 013415659
Report Date: 05/31/2024
Date Signed: 05/31/2024 12:20:42 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 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
04/02/2024 and conducted by Evaluator Janai McClain

PUBLIC

COMPLAINT CONTROL NUMBER: 02-CC-20240402143912

FACILITY NAME:	NIKASIA CHILD CARE CENTER		FACILITY NUMBER:	013415659
ADMINISTRATOR:	LEWIS, GWENDOLYN		FACILITY TYPE:	830
ADDRESS:	4143 MAC ARTHUR BOULEVARD		TELEPHONE:	(510) 531-9130
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94619
CAPACITY:	8	CENSUS: 3	DATE:	05/31/2024
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Nikita Lewis		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff member violated the children's personal rights

INVESTIGATION FINDINGS:

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On 5/31/2024 Licensing Program Analyst (LPA) Janai McClain conducted an unannounced visit to deliver findings for the above allegation. LPA met with assistant Nikita Lewis.

During the investigation, LPA conducted facility inspection, observations, record review, interviews, and obtained documents. During interviews LPA received conflicting information and is not able to determine if a child's personal rights were violated while in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated.

Exit interview conducted and report reviewed with Nikita Lewis. Notice of Site visit was provided and must be posted for 30 days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Janai McClain	TELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

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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