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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013421935
Report Date: 05/12/2023
Date Signed: 05/12/2023 01:08:03 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 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
03/16/2023 and conducted by Evaluator Russell Haderer
COMPLAINT CONTROL NUMBER: 52-CC-20230316132347
FACILITY NAME:WILSON, DANAFACILITY NUMBER:
013421935
ADMINISTRATOR:WILSON, DANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 321-1232
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:14CENSUS: 9DATE:
05/12/2023
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Dana WilsonTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Personal Rights - Provider leaves day care children in highchairs for an extended period of time.
INVESTIGATION FINDINGS:
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On 5/12/2023 at approximately 12:00pm, Licensing Program Analyst (LPA) Russ Haderer arrived unannounced to complete the complaint investigation for an allegation of violation of Personal Rights. Present in the home today was the licensee, and 9 children in care (3 infants; 6 two-years old) and a parent volunteer (parent of a child in care). The facility is in ratio today.

The complainant alleged that children were left in their highchairs for hours and left to stand in their Pack and Play and supplied photo evidence from different days showing children sitting in their highchairs with no food on their trays. The photos also revealed other children left standing alone in their cribs.

LPA was present on 3/20/2023 to open the investigation and observed two children sitting in highchairs without food on their trays for a substantial period of time (approximately 30 minutes), one child was eventually fed a banana. The children were then removed from their chairs and taken outside.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023
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 3
Control Number 52-CC-20230316132347
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: WILSON, DANA
FACILITY NUMBER: 013421935
VISIT DATE: 05/12/2023
NARRATIVE
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Based on observation made by LPA on the 3/20/2023 visit and the photo evidence from the reporting party, the licensee did not comply with the section cited above of maintaining the personal rights of a children by subjecting them to sit in their highchairs at times other than meal times (with no food on their trays indicating they were eating) and left children to stay in their cribs when they were not napping.

Children kept in highchairs at times other than meal times and in their cribs when not napping and left alone in cribs other than nap time is considered a form of restraint and a violation of personal rights which poses a potential health and safety risk to persons in care.

Based on LPAs personal observations, photos supplied by the reporting party and interviews, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED.

California Codes of Regulations, 102423(a)(2), are being cited on the attached LIC. 9099D.

An exit interview was conducted where the citation and plan of correction were discussed. Appeal rights were given and explained to the licensee. Notice of Site Visit was issued and must be posted for 30 days.

See LIC 9099D for corrective action to be taken.

SUPERVISOR'S NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 52-CC-20230316132347
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: WILSON, DANA
FACILITY NUMBER: 013421935
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/15/2023
Section Cited
CCR
102423(a)(2)
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102423 Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights:
(2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
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Licensee will review two CCLD online videos regarding Children’s Personal Rights and Supervising Children in family child care. After viewing the videos, licensee will complete the questionnaires and submit the original ink-signed and dated copies to the LPA.
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This requirement was not met as evidenced by:
Based on observation and photo evidence, the licensee did not comply with the section cited above of maintaining the personal rights of a children subjecting them to sit in their highchairs at times other than meal times, which is considered a form of restraint and a violation of personal rights which poses a potential health and safety risk to persons in care.
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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: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3