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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013422467
Report Date: 09/15/2022
Date Signed: 09/15/2022 04:00:24 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
07/29/2022 and conducted by Evaluator Arminder Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20220729120629
FACILITY NAME:COLIBRI PRESCHOOLFACILITY NUMBER:
013422467
ADMINISTRATOR:MARIBEL GUERRAFACILITY TYPE:
850
ADDRESS:4420 PIEDMONT AVETELEPHONE:
(510) 547-1422
CITY:OAKLANDSTATE: CAZIP CODE:
94611
CAPACITY:49CENSUS: 28DATE:
09/15/2022
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:TIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Personal Rights
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Arminder Singh met with Co-Director, Juliana Romero to deliver the findings for the above allegation. It was alleged that children were engaged in inappropriate interactions between each other. The incident occurred in the outdoor yard at facility. Director and staff were supervising the outdoor yard when incident occurred, however they were not able to reach the children in time to stop the inappropriate interaction from happening. As a result of the inappropriate interaction between two children a child's personal rights was violated.

Per LPA's interviews and observation conducted, it was determined, the preponderance of evidence standard has been met. Therefore, the allegation is SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 is being cited on 9099-D page.


Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
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 2
Control Number 02-CC-20220729120629
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: COLIBRI PRESCHOOL
FACILITY NUMBER: 013422467
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/14/2022
Section Cited
CCR
101223(A)(2)
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Personal Rights. The licensee shall ensure that each child is accorded the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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By POC Date Director or CO-Director will send a letter to LPA Singh stating how they will train staff and their understanding of the Personal Rights regulation.
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This requirement was not met as evidenced by:
Director an staff were supervising children in the outdoor year when a child was involved in inappropriately interacting with another child. The child was not provided a healthful accommodation. Staff and Director were not able to stop the child in time resulting in child's personal right being violated.
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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: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2