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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013421292
Report Date: 04/13/2023
Date Signed: 04/13/2023 05:29:06 PM

Substantiated


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
04/11/2023 and conducted by Evaluator Indira Loza
COMPLAINT CONTROL NUMBER: 02-CC-20230411133038

FACILITY NAME:RAYMOND, DOROTHEAFACILITY NUMBER:
013421292
ADMINISTRATOR:RAYMOND, DOROTHEAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 938-6666
CITY:BERKELEYSTATE: CAZIP CODE:
94706
CAPACITY:14CENSUS: 8DATE:
04/13/2023
UNANNOUNCEDTIME BEGAN:
09:01 AM
MET WITH:Sebastian Szekalski TIME COMPLETED:
05:36 PM
ALLEGATION(S):
1
2
3
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5
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9
License
INVESTIGATION FINDINGS:
1
2
3
4
5
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9
10
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13
On April 13, 2023 at 9:01am Licensing Program Analyst (LPA) Indira Loza met with Assistants Sebastian Szekalski and Kristen Garcia to continue the investigation for the above allegation. Present during the inspection were the Licensee's two assistants and six preschool age children and one infant. A third assistant, Rajanique Graves-Smith, arrived at around 12:30pm. LPA conducted a tour of the home for a Health and Safety check.

Based on interviews, the Licensee and staff confirmed that the Licensee was out of state for three months, which is more than the 20% allowance in the regulations. The preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. However a citation will not be issued due to the same allegation on complaint control: 02-CC-20230308090005 had the same allegation which received a Type B citation on April 13, 2023.

Exit interview conducted. Report and Appeal Rights provided to Kristen Garcia.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023
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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