073408461-9-11-2024-02-CC-SJON-DA6PTZ-20241018113646

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 073408461
Report Date: 09/11/2024
Date Signed: 09/11/2024 04:45:39 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
07/19/2024 and conducted by Evaluator Cherie Acosta

COMPLAINT CONTROL NUMBER: 02-CC-20240719085825

FACILITY NAME:	SIAMER, NACERA		FACILITY NUMBER:	073408461
ADMINISTRATOR:	SIAMER, NACERA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 240-5665
CITY:	BRENTWOOD	STATE: CA	ZIP CODE:	94513
CAPACITY:	14	CENSUS: 10	DATE:	09/11/2024
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Nacera Siamer		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Provider is utilizing inappropriate form of discipline.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cherie Acosta and Joe Mary Vargas conducted an unannounced visit to investigate the above allegation. LPAs met with licensee Nacera Siamer.

During the investigation LPAs conducted interviews. Based on the investigation it is determined that staff have hit children on the arm with an open hand and grabbed children by the arm.

Based on interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is to be substantiated

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie Acosta	TELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024

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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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
07/19/2024 and conducted by Evaluator Cherie Acosta

COMPLAINT CONTROL NUMBER: 02-CC-20240719085825

FACILITY NAME:	SIAMER, NACERA		FACILITY NUMBER:	073408461
ADMINISTRATOR:	SIAMER, NACERA		FACILITY TYPE:	810
ADDRESS:	1200 HOLSAPPLE WAY		TELEPHONE:	(415) 240-5665
CITY:	BRENTWOOD	STATE: CA	ZIP CODE:	94513
CAPACITY:	14	CENSUS: 10	DATE:	09/11/2024
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Nacera Siamer		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Provider puts children in the bathroom alone on time-out

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cherie Acosta and Joe Mary Vargas conducted an unannounced visit to investigate the above allegation. LPAs met with licensee Nacera Siamer.

During the investigation LPAs conducted interviews. It was reported by another party that licensee uses the bathroom for time-outs for children. During the investigation LPA received conflicting information.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated
Notice of Site Visit was provided and must be posted for 30 days.
Exit interview and report reviewed with Nacera Siamer.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie Acosta	TELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 4 of 4

Control Number 02-CC-20240719085825

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: SIAMER, NACERA	FACILITY NUMBER: 073408461
	VISIT DATE: 09/11/2024

NARRATIVE

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The attached type A violation is cited today and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC9224). The LIC 9224 must be placed in the child's file to be reviewed by licensing.

Notice of Site Visit was provided and must be posted for 30 days.
Exit interview and report reviewed with Nacera Siamer.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie Acosta	TELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 02-CC-20240719085825

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: SIAMER, NACERA	FACILITY NUMBER: 073408461
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/11/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type A 09/12/2024 Section Cited CCR 102423(a)(4)	1 2 3 4 5 6 7	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, the following:	1 2 3 4 5 6 7	Licensee shall develop a written plan of action to ensure children's rights are not violated. Licensee shall submit a copy of this plan to CCL by 9/12/24.
	8 9 10 11 12 13 14	To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation...but not limited to: interference with eating, sleeping... or aids to physical functioning.This requirement was not met as evidenced by:Staff hit and grab children's arm which is an immediate risk to personal rights of children in care	8 9 10 11 12 13 14	• 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.
	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: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie Acosta	TELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024

LIC9099 (FAS) - (06/04)

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