013419457-3-14-2023-02-CC-MMEA-CQ5TMJ-20230321145110

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 013419457
Report Date: 03/14/2023
Date Signed: 03/14/2023 03:01:10 PM

Unsubstantiated

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
02/10/2023 and conducted by Evaluator Catherine Fernandes

PUBLIC

COMPLAINT CONTROL NUMBER: 02-CC-20230210153751

FACILITY NAME:	PETER PAN ACADEMY		FACILITY NUMBER:	013419457
ADMINISTRATOR:	CLEMENT, THERESA		FACILITY TYPE:	830
ADDRESS:	3171 MECARTNEY ROAD		TELEPHONE:	(510) 523-5050
CITY:	ALAMEDA	STATE: CA	ZIP CODE:	94502
CAPACITY:	11	CENSUS: 6	DATE:	03/14/2023
		UNANNOUNCED	TIME BEGAN:	02:23 PM
MET WITH:	Julia DeMauri		TIME COMPLETED:	03:10 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Child in care sustained unexplained injuries
Staff did not inform child's authorized representative of child's incident

INVESTIGATION FINDINGS:

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

On 3/14/23, at 2:23PM, Licensing Program Analyst (LPA) Catherine Fernandes arrived unannounced to deliver the findings to the above allegations and met with acting Director Julia DeMauri. Present in care were six infants and two additional staff members. During the investigation LPA Fernandes conducted interviews with parents, staff and children, observed the classroom, reviewed center documentation regarding the allegations and did a walk through of the center.
Based on evidence the child did sustain a mark on the arm, however it is unclear where or when the injury occurred. Interviews regarding the second allegation indicated conflicting information about receiving written or verbal reports regarding injuries to the children while in care. Therefore, the above allegations are unsubstantiated, although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

Exit interview conducted
Report, Appeals Rights and Notice of Site Visit provided

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine Fernandes	TELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

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