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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015700512
Report Date: 11/30/2023
Date Signed: 12/01/2023 05:40:44 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
11/09/2023 and conducted by Evaluator April Wright
COMPLAINT CONTROL NUMBER: 52-CC-20231109135553
FACILITY NAME:SAFARI KID - IRVINGTONFACILITY NUMBER:
015700512
ADMINISTRATOR:KIRAN, GOWRIFACILITY TYPE:
850
ADDRESS:41811 BLACOW ROADTELEPHONE:
(510) 573-4871
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY:105CENSUS: 65DATE:
11/30/2023
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Arprita Biswas and Gowri KiranTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Neglect/Lack of Supervision - Due to lack of supervision daycare child sustained a fall which resulted in a fracture
INVESTIGATION FINDINGS:
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On November 30th, 2023 at approximately 1:15pm, Licensing Program Analyst (LPA) April Wright, met with Assistant Center Director Arprita Biswas and Owner Gowri Kiran, for an unannounced complaint follow up inspection. The purpose of the visit is to deliver the complaint investigation findings. LPA Wright conducted a Health & Safety inspection. Present during the inspection was 65 preschool/toddler age children and 9 staff personnel.

During the course of the investigation, LPA conducted staff interviews, record reviews and review of incident reports.

This agency has investigated the complaint alleging that daycare child sustained a fall which resulted in a fracture. Based on admission, interviews conducted and review of center incident reports, the preponderance of evidence standard has been met, therefore, the allegation is SUBSTANTIATED. California Code of Regulations, Title 22, Division 12, Chapter 1, Section 101229(a)(1), is being cited as a Type A Violation ,see attached LIC 9099D. LPA provided LIC9224 to give to current families by 12/1/23 and all new families for 12 months, effective 12/1/23. This report must remain on file for three years.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
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
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
11/09/2023 and conducted by Evaluator April Wright
COMPLAINT CONTROL NUMBER: 52-CC-20231109135553

FACILITY NAME:SAFARI KID - IRVINGTONFACILITY NUMBER:
015700512
ADMINISTRATOR:KIRAN, GOWRIFACILITY TYPE:
850
ADDRESS:41811 BLACOW ROADTELEPHONE:
(510) 573-4871
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY:105CENSUS: 65DATE:
11/30/2023
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Arprita Biswas and Gowri KiranTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Reporting Requirements - Staff didn't provide child's authorized representative with an incident report
INVESTIGATION FINDINGS:
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3
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5
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13
On November 30th, 2023 at approximately 1:15pm, Licensing Program Analyst (LPA) April Wright, met with Assistant Center Director Arprita Biswas and Owner Gowri Kiran, for an unannounced complaint follow up inspection. The purpose of the visit is to deliver the complaint investigation findings. LPA Wright conducted a Health & Safety inspection. Present during the inspection was 65 preschool/toddler age children and 9 staff personnel.
During the course of the investigation, LPA conducted staff interviews, record reviews and review of incident reports.

This agency has investigated the complaint alleging Staff didn't provide child's parent/authorized representative with an incident report. Based on admission, interviews conducted and review or records/incident reports, The preponderance of evidence standard has been met, therefore, the allegation is SUBSTANTIATED. California Code of Regulations, Title 22, Division 12, Chapter 1, Section 101212(f), is being cited as a Type A Violation ,see attached LIC 9099D. LPA provided LIC9224 to give to current families by 12/1/23 and all new families for 12 months, effective 12/1/23. This report must remain on file for three years.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 52-CC-20231109135553
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: SAFARI KID - IRVINGTON
FACILITY NUMBER: 015700512
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/01/2023
Section Cited
HSC
101229(a)(1)
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Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher at any time
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Assistant Center Director will have Staff will watch the "Supervising Children in Child Care Centers" on the CCLD website. The facility representative will have all the staff sign and date the written statement a swell as provide sign in sheet for meeting.
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This requirement was not met as evidenced by:
Based on admission, interviews conducted and review or records/incident reports, child was not properly supervised which resulted in injury, which poses an immediate health and safety risk to children in care.
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Type A
12/01/2023
Section Cited
HSC
101212(f)
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Reporting Requirements
(f) The items specified in (d)(1)(A) through (H) above shall also be reported to the child's authorized representative.

This requirement was not met as evidenced by:
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Assistant Director will have meeting to go over procedure for reporting incidents to parent/authorized representatives.
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Based on admission, interviews conducted and review or records/incident reports, staff did not provide a incident report to the child's parent/representative, which poses an immediate health and safety risk to children 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: April Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3