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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073408503
Report Date: 08/19/2021
Date Signed: 08/19/2021 11:28:03 AM



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
05/28/2021 and conducted by Evaluator Paul Peterson
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20210528101940

FACILITY NAME:BOLDEN-KRAMER, RACHELFACILITY NUMBER:
073408503
ADMINISTRATOR:BOLDEN-KRAMER, RACHELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 779-2786
CITY:EL SOBRANTESTATE: CAZIP CODE:
94803
CAPACITY:14CENSUS: 1DATE:
08/19/2021
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Rachel Bolden KramerTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Day care children engaged in inappropriate interaction in the facility.
INVESTIGATION FINDINGS:
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LPA Petersen conducted an unannounced complaint investigation site inspection for this facility at 10:00am. Present at the time of this inspection was licensee, Rachel Bolden-Kramer, along with licensee's 21 month old child. There were no other children in care.

Based on information gathered through interviews it was determined that a 3 year old child in care had his private area touched by a toddler while the child was using the bathroom. Therefore the preponderance of evidence standard has been met and the above allegation has been substantiated.

California Code of Regulations, Tittle 22, is being cited on the attached LIC 9099D for a Type B citation.

An exit interview was conducted with licensee, Rachel Bolden-Kramer, and a plan of correction was discussed. Appeal rights were given and explained. A printed copy of this report as well as licensee’s appeal rights were provided.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 368-2672
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
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 02-CC-20210528101940
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: BOLDEN-KRAMER, RACHEL
FACILITY NUMBER: 073408503
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/19/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/03/2021
Section Cited
CCR
102423(a)(1)
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102423(a) 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:

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Licensee agrees to develop and submit a written plan specifically regarding children's privacy while using the bathroom by the POC date. The plan is to be signed by all present and future staff working at this facility. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation
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(1) To be treated with dignity in his/her personal relationship with staff and other persons. This requirement was not met as evidenced by an interaction between children in care which involved a three year old child being touched on his private area by a toddler while the two children were in the bathroom posing a potential risk the child health/safety.
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and $100 per day until corrected.
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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: Mayla MendozaTELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 368-2672
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3