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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013414785
Report Date: 05/01/2020
Date Signed: 08/27/2020 04:18:15 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
04/30/2020 and conducted by Evaluator Brittany Newton
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20200430084032
FACILITY NAME:PURNELL, DEVVINFACILITY NUMBER:
013414785
ADMINISTRATOR:PURNELL, DEVVINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 708-0797
CITY:BERKELEYSTATE: CAZIP CODE:
94702
CAPACITY:14CENSUS: 0DATE:
05/01/2020
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Devvin Purnell - TelevisitTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Personal Rights
INVESTIGATION FINDINGS:
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This is an amended version of the original report.
On 05/01/2020, Licensing Program Analyst (LPA) Brittany Newton and Regional Manager Diane Perez made an unannounced televisit phone call to Licensee Devin Purnell due to COVID-19 restrictions, for the purpose of opening a complaint investigation. The licensee currently doesn't have children in care.
Throughout the course of the investigation, LPA conducted interviews, reviewed documentation and photographs. Interviews conducted revealed the licensee has allowed at least one infant to sleep in a swing on multiple occasions.

Therefore, the above allegations is found to be Substantiated. California Code of Regulations, (Title 22, Division 12) is being cited on the attached LIC9099 D. The attached Type A deficiency is being cited and must be corrected by the due date. Parent's of children in care must receive a copy of this report and a signed LIC 9224 must be placed in each child's file.
Exit interview conducted. Facility was provided a copy of their appeal rights and this report via email. This report must be kept available for public review for 3 years.
Substantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Darryl JeffersonTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Diane PerezTELEPHONE: (510) 622-2594
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2020
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-20200430084032
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: PURNELL, DEVVIN
FACILITY NUMBER: 013414785
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/01/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
05/02/2020
Section Cited
CCR
102423(a)(2)
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Personal Rights
(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. (2) To receive safe, healthful, and comfortable accomodations,
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Licensee agrees to submit a written document stating they will ensure not to use swings for sleeping or eating under any circumstances. Licensee shall review the videos and information on https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep and submit documentation to LPA by 05/02/20.
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Based on interviews conducted and photographs reviewed, licensee has been allowing infants to sleep in swings which is an immediate Health, Safety, or Personal Rights risk to children in care.
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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) 873-6408
LICENSING EVALUATOR NAME: Brittany NewtonTELEPHONE: (510) 622-2594
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2020
LIC9099 (FAS) - (06/04)
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