013421000-5-26-2021-02-CC-LDYN-C3RALV-20210607001938

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 013421000
Report Date: 05/26/2021
Date Signed: 05/26/2021 09:09:09 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
03/09/2021 and conducted by Evaluator Melissa Guirit

PUBLIC

COMPLAINT CONTROL NUMBER: 02-CC-20210309095743

FACILITY NAME:	HEARNE, KAREN		FACILITY NUMBER:	013421000
ADMINISTRATOR:	HEARNE, KAREN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 434-1080
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94602
CAPACITY:	14	CENSUS: 5	DATE:	05/26/2021
		UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Karen Hearne		TIME COMPLETED:	09:20 AM

ALLEGATION(S):

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Licensee does not properly supervise a daycare child while in care

INVESTIGATION FINDINGS:

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On 05/26/21, Licensing Program Analyst (LPA), Melissa Guirit met with licensee, Karen Hearne for an unannounced complaint investigation. Present for this investigation was licensee and five children. A tour of the family day care home was conducted by the licensee.

It was reported that the licensee does not properly supervise a daycare child while in care. During the investigation, observations and interviews were conducted. Based on interviews and observations, LPA is not able to determine if the above allegation did or did not occur.

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 deemed unsubstantiated.

There are no deficiencies cited during today’s inspection. This report shall remain on file for 3 years. Notice of Site Visit, copy of report and appeal rights provided. Exit interview conducted with licensee.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Melissa Guirit	TELEPHONE: (510) 566-8898
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2021

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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