013416346-10-13-2021-02-CC-SJON-C9A56D-20211130184031

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 013416346
Report Date: 10/13/2021
Date Signed: 10/13/2021 10:42:46 AM

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
10/07/2021 and conducted by Evaluator Diana Campos

PUBLIC

COMPLAINT CONTROL NUMBER: 02-CC-20211007092732

FACILITY NAME:	OUSD - INTERNATIONAL CDC		FACILITY NUMBER:	013416346
ADMINISTRATOR:	HERRERA, CHRISTIE		FACILITY TYPE:	850
ADDRESS:	2825 INTERNATIONAL BOULEVARD		TELEPHONE:	(510) 532-7267
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94601
CAPACITY:	72	CENSUS:	DATE:	10/13/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Vonzele Reed		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Neglect/Lack of Supervision

INVESTIGATION FINDINGS:

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

On 10/13/2021 at 9:30am, Licensing Program Analyst (LPA) Diana Campos arrived at the facility for an unannounced complaint investigation regarding the above allegation. LPA met with Site Supervisor Vonzele Reed. Present during the investigation were 32 children in care and 9 staff.

The above allegation was previously addressed during a case management inspection conducted on 8/23/2021. At that time, Licencensing Program Analyst's (LPA's) Cherie Acosta and Diana Campos conducted interviews and reviewed documents to make a determination of whether or not a violation occurred. There was enough information to support that a violation of the regulation occurred and a deficiency was cited on 8/23/2021. This complaint is being substantiated today based on information previously obtained from the interviews conducted and documents reviewed during the case management inspection conducted on 8/23/2021. There are no deficiencies being cited today. This report will remain on file for 3 years. Exit interview conducted with Mr. Reed. Notice of Site Visit provided to post for the next 30 days.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana Campos	TELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021

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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