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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434408036
Report Date: 07/19/2019
Date Signed: 07/19/2019 12:31:57 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 STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/19/2019 and conducted by Evaluator Yangcheng Huang
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20190619094615
FACILITY NAME:AMES CHILD CARE CENTERFACILITY NUMBER:
434408036
ADMINISTRATOR:STEVENS, IDAFACILITY TYPE:
830
ADDRESS:BLDG. 270 R.T. JONES ROADTELEPHONE:
(650) 604-5100
CITY:MOFFETT FIELDSTATE: CAZIP CODE:
94035
CAPACITY:52CENSUS: 33DATE:
07/19/2019
UNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Ida StevensTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Facility is operating out of ratio.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Oscar Huang, conducted an unannounced complaint visit to the facility today to deliver investigation findings. LPA met with Director, Ida Stevens and explained the nature of today's visit to her. Based on interviews of director & staff, and reviewed staff time sheets & infant sign-in/out logs on site during the investigation course. LPA learnt that the facility was operating over Staff/Infant ratio for a short period in between 8:30am to 9:00am on 06/18/19 before additional staff arrived at work to put back in ratio.

LPA concluded that the preponderance of evidence standard has been met and the allegation noted above is therefore SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12 & Chapter 1 number), are being cited on the attached LIC 9099-D. A notice of site visit was issued and posted near the facility entrance, and must remain posted for 30 consecutive days.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: (408) 334-8321
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2019
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 52-CC-20190619094615
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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: AMES CHILD CARE CENTER
FACILITY NUMBER: 434408036
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/26/2019
Section Cited
CCR
101416.5(b)
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Staff-Infant Ratio. There shall be a ratio of one teacher for every four infants in attendance. This requirement was not met as evidenced by: through the investigation course, LPA learnt that there were 12 infants with only two staff on 6/18/2019 for a short period in between 8:30am to 9:00am.
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Director shall forward a written plan of correction indicating methods and procedures implemented to ensure the facility maintain within the ratio of staff/infant at all time, and to schedule a title 22 staff/infant ratio supervision training for all staff. A copy of agenda with plan including names and signatures
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This poses a potential safety & health risk to infants in care.
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of all staff who attended, shall be sent to CCL by the POC due date.
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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: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: (408) 334-8321
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2019
LIC9099 (FAS) - (06/04)
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