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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013420549
Report Date: 10/15/2020
Date Signed: 10/15/2020 11:50:49 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
09/04/2020 and conducted by Evaluator Caroline Colson
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20200904145548

FACILITY NAME:ALBANY CHILDREN'S CENTERFACILITY NUMBER:
013420549
ADMINISTRATOR:MANSKER, ANNAFACILITY TYPE:
850
ADDRESS:720 JACKSON STREETTELEPHONE:
(510) 559-6590
CITY:ALBANYSTATE: CAZIP CODE:
94706
CAPACITY:85CENSUS: DATE:
10/15/2020
UNANNOUNCEDTIME BEGAN:
11:02 AM
MET WITH:Alexia RitchieTIME COMPLETED:
11:20 AM
ALLEGATION(S):
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Reporting Requirements - Facility did not report an incident to Licensing
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Caroline Colson called and spoke to Alexia Ritchie, Executive Director, regarding the above allegation. An allegation was made that a staff member violated a child's personal rights by hitting the child during nap time. The usual incident occurred at the facility and wasn't reported to the Department by the next working day during normal business hours. In addition, a written report containing the allegation wasn't submitted within seven days to the Department. Based on LPA's interviews which were conducted and a record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, 101212(d) is being cited on the attached LIC 9099 D.

The attached type B deficiency is being cited today and must be corrected by the due date. An exit interview was conducted. Appeal rights were given and discussed. This report must be available for public review for 3 years.

Please See LIC 9099 D for deficiency
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Caroline ColsonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2020
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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Control Number 02-CC-20200904145548
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: ALBANY CHILDREN'S CENTER
FACILITY NUMBER: 013420549
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/15/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/30/2020
Section Cited
CCR
101212(d)
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Reporting Requirements
Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.
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By POC Due Date: Licensee will submit an unusual incident report to Community Care Licensing by October 30, 2020. Licensee will view the video for Child Care Reporting Requirments and submit a summary by October 30, 2020.
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The facility didn't call to report an unusual incident or submit a written report within seven days. This requirement was not met as evidenced by document review and licensee interview. This poses a potential health and safety risk to children in care.
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Failure to correct will result in a $100.00 per day civil penalty until corrected. Repeat violations are 250.00 per violation and $100.00 per day until corrected.
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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: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Caroline ColsonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2020
LIC9099 (FAS) - (06/04)
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