070212841-2-9-2023-02-CC-SJON-CPBUTJ-20230223145201

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 070212841
Report Date: 02/09/2023
Date Signed: 02/09/2023 02:36:45 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
02/07/2023 and conducted by Evaluator Monica Mathur

PUBLIC

COMPLAINT CONTROL NUMBER: 02-CC-20230207152302

FACILITY NAME:	SRVSACCA- KIDS COUNTRY (SYCAMORE CENTER)		FACILITY NUMBER:	070212841
ADMINISTRATOR:	SHICHIDA, DANA		FACILITY TYPE:	840
ADDRESS:	2200 HOLBROOK DRIVE		TELEPHONE:	(925) 736-3638
CITY:	DANVILLE	STATE: CA	ZIP CODE:	94506
CAPACITY:	147	CENSUS: 26	DATE:	02/09/2023
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Dana Shichida		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Personal Rights - staff handled day care child in a rough manner.

INVESTIGATION FINDINGS:

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On 2/9/23 Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Initial Complaint Investigation at SRVSACCA Kids Country Sycamore Center. LPA met with Director, Dana Shichida.

Complainant alleges staff handled day care child in a rough manner.
On 2/1/23 facility self reported an unsual incident where staff member S1 roughly mishandled child C1 during outdoor activity. LPA conducted Case Management investigation on 2/2/23 facility was cited Type A for violation of Personal Rights on report 809 dated 2/2/23. S1 employment was terminated on 2/2/23 and facility submitted plan of corrections.

Based on the interviews and information obtained throughout the investigation, the preponderance of evidence standard has been met. Therefore, the allegation is SUBSTANTIATED. However, since facility was already cited on 2/2/23 for same incident, no deficiency is being cited today. Facility is reminded to reinforce implementaiton of personal righs, conduct ongoing staff training, active visual supervision. A Non Compliance Conference with Regional Office will be scheduled to discuss citation.

No deficiency cited today. Exit interview was conducted with Director, Dana Shichida. Appeal rights were provided. NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 DAYS.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

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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