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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070213553
Report Date: 05/17/2022
Date Signed: 05/17/2022 02:59:41 PM


Document Has Been Signed on 05/17/2022 02:59 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:MOORE-BANGURA, LINDAFACILITY NUMBER:
070213553
ADMINISTRATOR:MOORE-BANGURA, LINDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 262-9213
CITY:RICHMONDSTATE: CAZIP CODE:
94806
CAPACITY:14CENSUS: DATE:
05/17/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Linda Moore-BanguraTIME COMPLETED:
02:41 PM
NARRATIVE
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LPA Nyeesha Blount and Chere Acosta arrived to conduct an unannounced case management and POC visit present during today's visit was 6 children and 1 infants 14 enrolled total.. During the course of this Investigation IB also investigated a complaint of lack of supervision and physical abuse regarding Alternative family services LInda Moore-Bangura regarding the same incident (CD2622-02028) the findings for that investigation are substantiated.

LPAs performed a health & safety check. See 809-D for the TYPE deficiency that is being cited on today's visit. An exit interview was conducted. The licensee was provided a copy of their appeal rights (LIC9058 01/16) and their signature on this form acknowledges receipt of these right

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SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Nyeesha BlountTELEPHONE: (510) 566-2319
LICENSING EVALUATOR SIGNATURE:
DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/13/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


Document Has Been Signed on 05/17/2022 02:59 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: MOORE-BANGURA, LINDA

FACILITY NUMBER: 070213553

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 05/17/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/18/2022
Section Cited

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Personal Rights~
Each child receiving service from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. these rights include, but are not limited to, the following; To be treated with dignity in his/her personal relationship with staff and other persons.
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The requirement has not been met evidenced by document review and licensee interview. LIcensee would hit the daycare children with her hand, and sometimes would hit fosterchild in front of the day care children. This poses an Immediate risk to children in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
Type A
05/18/2022
Section Cited

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Reporting Requirements~
the Licensee shall report the following information the Department by telephone of fax within the Department's next business day and during normal working hours (8am to 5pm) (f) As soon as possible but no later then the same business day, the licensee shall notiify a child's parent or authorized reprensentative regardless of the injuries or acts that affect that child as specified in Health and Safety Code Section 1597.467(a) (1) Any injury suffered by a child in care shall be reported to that child's parent or auhorized representative regardless of treatment by a medical professional.
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This requirement has not been met evidenced by licensee did not notifiy parent or licensing of injury of the child. which poses an immediate risk to children in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
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: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Nyeesha BlountTELEPHONE: (510) 566-2319
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3


Document Has Been Signed on 05/17/2022 02:59 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: MOORE-BANGURA, LINDA

FACILITY NUMBER: 070213553

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 05/17/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/18/2022
Section Cited

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Personal Rights~
Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but not limited to, the following; (2) to receive safe, healthful, and comfortable accommodations, furnishings and equipment.
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This requirement has not been met evidenced by all child was bringing Epipen to facility and kept in cubby, which was accesibile to all children, whcih posses an immediate risk to children in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
Type A
05/18/2022
Section Cited

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Personal rights ~ Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to: (1) to be treated with diginity in his/her pesonal relationship with staff and other persons.
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This requirement has not been met evidenced by lack of supervision where a child was being choked at daycare,which posess an immediate risk to children in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
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: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Nyeesha BlountTELEPHONE: (510) 566-2319
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3