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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013420689
Report Date: 10/06/2021
Date Signed: 10/06/2021 12:43:01 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 STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/30/2021 and conducted by Evaluator Briana Plumboy
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20210930163752
FACILITY NAME:OCAMPO, LETICIAFACILITY NUMBER:
013420689
ADMINISTRATOR:OCAMPO, LETICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 355-4539
CITY:SAN LEANDROSTATE: CAZIP CODE:
94577
CAPACITY:14CENSUS: 14DATE:
10/06/2021
UNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Leticia Ocampo- LicenseeTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights- Staff hit day care child
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/6/21 at 12:05pm, Licensing Program Analyst (LPA) Briana Plumboy met with Licensee Leticia Ocampo to deliver the finding of an Complaint filed against the facility regarding the allegation of personal rights. Present for the inspection was 4 infants, 10 preschool age children, and 2 fingerprint clear and associated staff.
Based on interviews conducted, file review, and observations, the allegation a staff hit a child in care is unsubstantiated. Although the allegation 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 allegation is UNSUBSTANTIATED.
A notice of site visit was given and must remain posted for 30 days.
Appeal Rights were given and discussed. An exit interview was conducted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
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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