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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013418948
Report Date: 01/31/2022
Date Signed: 01/31/2022 11:58:43 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
01/25/2022 and conducted by Evaluator Monica Mathur
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20220125102323
FACILITY NAME:SCOTT, VICKTORIYAFACILITY NUMBER:
013418948
ADMINISTRATOR:SCOTT, VICKTORIYAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 287-6873
CITY:BERKELEYSTATE: CAZIP CODE:
94702
CAPACITY:14CENSUS: 5DATE:
01/31/2022
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Vicktoriya ScottTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Daycare child wandered away
INVESTIGATION FINDINGS:
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On 1/31/22 at 9:45 AM Licensing Program Analysts (LPAs) Monica Mathur and Michelle Sutton conducted an unannounced Complaint Investigation at Vicktoriya Scott's family day care. LPAs met with Licensee, Vicktoriya and explained purpose of investigation. Present in the home were Licensee, 1 Helper, 5 children.
Complainant alleges that a day care child wandered away from the home. During the course of the investigation, LPA inspected the facility, reviewed records and conducted interviews. It was determined that on 1/24/22 at about 3:30 PM nap time Child 1 (C1) got away through 3 unlocked gates and was found unattended by a neighbor on the street intersection. Neighbor brought C1 back to the facility. Licensee was not present in the home when incident occured. Helpers S1 and S2 were not aware a child was missing. Based on the interviews and information obtained throughout the investigation, the preponderance of evidence standard has been met.

continued on 9099 C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2022
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 7
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
01/25/2022 and conducted by Evaluator Monica Mathur
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20220125102323

FACILITY NAME:SCOTT, VICKTORIYAFACILITY NUMBER:
013418948
ADMINISTRATOR:SCOTT, VICKTORIYAFACILITY TYPE:
810
ADDRESS:1718 CHESTNUT ST.TELEPHONE:
(510) 287-6873
CITY:BERKELEYSTATE: CAZIP CODE:
94702
CAPACITY:14CENSUS: 5DATE:
01/31/2022
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Vicktoriya ScottTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee did not report unusual incident to Licensing Department
INVESTIGATION FINDINGS:
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2
3
4
5
6
7
8
9
10
11
12
13
On 1/31/22 at 9:45 AM Licensing Program Analysts (LPAs) Monica Mathur and Michelle Sutton conducted an unannounced Complaint Investigation at Vicktoriya Scott's family day care. LPAs met with Licensee, Vicktoriya and explained purpose of investigation. Its determined that Licensee did not fulfill reporting requirements by not reporting an unusual incident to Licensing Department about a day care child wandering away from the home. Therefore, the allegation is SUBSTANTIATED. Finding for the above allegation was delivered during the inspection. California Code of Regulations, Title 22, Division 12 is being cited on 9099-D page.

Exit interview was conducted with Licensee, Vicktoriya. Notice of Site Visit was issued.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 02-CC-20220125102323
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: SCOTT, VICKTORIYA
FACILITY NUMBER: 013418948
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/31/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/04/2022
Section Cited
CCR
102416.2(b)(2)
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102416.2 Reporting Requirements (b) The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) [...]. This requirement is not met as evidenced by:
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By 2/4/22 Licensee will send written statement of her understanding of this regulation.
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Per LPA's investigation, Licensee did not report an unusual incident about a child left unattended to CCL. This poses a potential risk to health safety of children.
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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: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 02-CC-20220125102323
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: SCOTT, VICKTORIYA
FACILITY NUMBER: 013418948
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/31/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/01/2022
Section Cited
CCR
102417(a)
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102417 Operation of a Family Child Care Home (a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times [...]. This requirement is not met as evidenced by:
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By 2/1/22 Licensee agreed to:
1. submit written statement of what measures will be taken to ensure supervision of children at all times
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9
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Per LPA's investigation, on 1/24/22 at 3:30 PM nap time Child 1 (C1) got away through 3 unlocked gates and was found unattended by a neighbor on the street intersection. Neighbor brought C1 back to the facility. Licensee was not present in the home when incident occured. Helpers S1,S2 were not aware a child was missing. This posed an immediate risk to safety of child. Civil penalty of $500 is assessed.
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By 2/7/22 conduct staff training, watch video on Supervision on CCLD website.
www.ccld.ca.gov
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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: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 02-CC-20220125102323
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: SCOTT, VICKTORIYA
FACILITY NUMBER: 013418948
VISIT DATE: 01/31/2022
NARRATIVE
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Therefore, the allegation is SUBSTANTIATED. Finding for the above allegation was delivered during the inspection. California Code of Regulations, Title 22, Division 12 is being cited on 9099-D page for ABSENCE OF SUPERVISION. A civil penalty of $500 was assessed. Licensee was informed that a Non Compliance Meeting will be scheduled soon.

Due to the issuance of a Type A Citation during today's inspection, a copy of this Licensing Report must be posted in the facility and given to each existing parent by the end of today or next day child is in care. Report also has to be provided to the parent of children who are enrolled over the next 12 months. In addition, a copy of the LIC 9224 Acknowledgement of Receipt of Licensing Reports must be signed by each parent and kept in each child's file.

Exit interview was conducted with Licensee, Vicktoriya. Appeal rights were provided.
A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 7
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
01/25/2022 and conducted by Evaluator Monica Mathur
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20220125102323

FACILITY NAME:SCOTT, VICKTORIYAFACILITY NUMBER:
013418948
ADMINISTRATOR:SCOTT, VICKTORIYAFACILITY TYPE:
810
ADDRESS:1718 CHESTNUT ST.TELEPHONE:
(510) 287-6873
CITY:BERKELEYSTATE: CAZIP CODE:
94702
CAPACITY:14CENSUS: 5DATE:
01/31/2022
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Vicktoriya ScottTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee did not report unusual incident to parent of child
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 1/31/22 at 9:45 AM Licensing Program Analysts (LPAs) Monica Mathur and Michelle Sutton conducted an unannounced Complaint Investigation at Vicktoriya Scott's family day care. LPAs met with Licensee, Vicktoriya and explained purpose of investigation. Its determined that Licensee did not fulfill reporting requirements by not reporting an unusual incident to parents of a child who wandered away from the home. Therefore, the allegation is SUBSTANTIATED. Finding for the above allegation was delivered during the inspection. California Code of Regulations, Title 22, Division 12 is being cited on 9099-D page.

Exit interview was conducted with Licensee, Vicktoriya. Notice of Site Visit was issued.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 02-CC-20220125102323
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: SCOTT, VICKTORIYA
FACILITY NUMBER: 013418948
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/31/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/04/2022
Section Cited
CCR
102416.2(f)
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2
3
4
5
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7
102416.2 Reporting Requirements (f) As soon as possible but no later then the same business day, the licensee shall notify a child's parent or authorized representative regardless of the injuries or acts that affect that child as specified in Health and Safety Code Section 1597.467(a). This requirement is not met as evidenced by:
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2
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By 2/4/22 Licensee shall send a written statement of her understanding of this regulation.
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9
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13
14
Per investigation, Licensee failed to report an unusual incident to parent of a child who wandered away from day care. This poses a potential risk to health and safety of children in care.
8
9
10
11
12
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14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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2
3
4
5
6
7
1
2
3
4
5
6
7
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: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2022
LIC9099 (FAS) - (06/04)
Page: 7 of 7