073402570-3-5-2020-02-CC-DPEZ-BMV5FM-20200319195521

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 073402570
Report Date: 03/05/2020
Date Signed: 03/05/2020 01:52:38 PM

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
01/27/2020 and conducted by Evaluator Paul Peterson

PUBLIC

COMPLAINT CONTROL NUMBER: 02-CC-20200127124520

FACILITY NAME:	JORDEN-FAULKNER, APRIL		FACILITY NUMBER:	073402570
ADMINISTRATOR:	JORDEN-FAULKNER, APRIL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 237-2870
CITY:	RICHMOND	STATE: CA	ZIP CODE:	94805
CAPACITY:	14	CENSUS: 0	DATE:	03/05/2020
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	April Jorden		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Day care child was transported without a car seat.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Paul Petersen conducted an unannounced complaint investigation site inspection for this facility at 1245. LPA met with licensee, April Jorden, who was present with no children in care. LPA reviewed with licensee the child safety seat requirements as verified by the California Department of Highway Patrol that all children under eight years of age and less than four foot nine inches tall require child safety seats while being transported in an automobile. On 02/04/20, LPA observed child C3, being transported in the facility van with a seat belt on but no child safety seat in place.

Therefore, the complaint above was substantiated and a Type B deficiency was cited. A copy of the appeal rights was provided and a notice of site visit was printed and posted and is to remain posted for 30 days. A copy of this report is to remain in the facility records for three years from today's date.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020

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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Control Number 02-CC-20200127124520

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: JORDEN-FAULKNER, APRIL	FACILITY NUMBER: 073402570
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/05/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/20/2020 Section Cited CCR 102417(k)	1 2 3 4 5 6 7	102417(k) All vehicle occupants must be secured in an appropriate restraint system. This facility was not in compliance with this requirement as evidenced by LPA's observation on 02/04/20, that child C3, who was verified to be under eight years of age was transported in the facility van without using	1 2 3 4 5 6 7	This deficiency was corrected while LPA was present as licensee posted a copy of the PUB269, Child Passenger Safety Law poster at this facility. Licensee also provided LPA with a written/signed statement of understanding of and adherance to the California Child Passenger Safety Seat Law. Failure to
	8 9 10 11 12 13 14	a child safety seat thereby posing a potential risk to the health and safety of the child.	8 9 10 11 12 13 14	correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020

LIC9099 (FAS) - (06/04)

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