013416167-9-21-2021-02-CC-LDYN-C7AK62-20210928073648

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 013416167
Report Date: 09/21/2021
Date Signed: 09/21/2021 04:58:19 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
07/01/2021 and conducted by Evaluator Phyllis Dyer

PUBLIC

COMPLAINT CONTROL NUMBER: 02-CC-20210701115742

FACILITY NAME:	COLEMAN, BEVERLY		FACILITY NUMBER:	013416167
ADMINISTRATOR:	COLEMAN, BEVERLY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 978-0744
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94603
CAPACITY:	14	CENSUS: 0	DATE:	09/21/2021
		UNANNOUNCED	TIME BEGAN:	04:20 PM
MET WITH:	Beverly Coleman		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Child sustained injuries while in care.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 9/21/21 at 4:20 p.m., Licensing Program Analyst L. Dyer met with licensee Beverly Coleman to provide the results of a Complaint Investigation. Due to COVID restrictions a tele-inspection was utilized using Duo. The facility is currently closed. It was alleged that a child sustained injuries while in care.
Licensee states the child was a normal preschooler. Licensee was very cautious with him as the parent was very particular about the child. She has a procedure of texting or calling parents immediately when children have an injury at the facility. The injury is then discussed with the parent. She provided recent texts she had sent to parents. Licensee stated the child was not injured at her facility, but at home. Complainant stated the child was injured at the facility as the licensee did not watch him closely enough.
Contradictory statements have been made by witnesses. Although the allegation of a child sustained injuries while in care 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 results are Unsubstantiated. Appeal rights and Notice of Site Visit were discussed and will be mailed. Exit interview conducted.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Phyllis Dyer	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Phyllis Dyer	TELEPHONE: (510) 725-7006
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021

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 1