013423040-9-7-2022-02-CC-MMEA-CJPMVZ-20220928095732

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 013423040
Report Date: 09/07/2022
Date Signed: 09/07/2022 04:34:07 PM

Unsubstantiated

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
07/26/2022 and conducted by Evaluator Indira Loza

PUBLIC

COMPLAINT CONTROL NUMBER: 02-CC-20220726105748

FACILITY NAME:	YMCA EASTLAKE CENTER		FACILITY NUMBER:	013423040
ADMINISTRATOR:	LOVETTE TRAMMEL		FACILITY TYPE:	850
ADDRESS:	1612-45TH AVE		TELEPHONE:	(510) 370-2966
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94601
CAPACITY:	60	CENSUS: 48	DATE:	09/07/2022
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Jessica Boataer & Monica Williams		TIME COMPLETED:	04:50 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Medication - Staff did not provide day care child with medication

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On September 7, 2022 at 9:45AM, Licensing Program Analyst (LPA) Indira Loza and Licensing Program Manager (LPM) Mayla Mendoza arrived unannounced on a complaint investigation inspection and met with Assistant Director Jessica Boataer. Later, Area Manager Monica Williams arrived.

LPA and LPM conducted staff interviews which indicated the child was given medication, but there are no records to show medication administered. Based on LPA and LPM interviews and information obtained throughout the investigation, the allegation is UNSUBSTANTIATED. 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 UNSUBSTANTIATED. No Deficiencies have been cited for the allegation.

An exit interview was conducted with Area Manager Monica Williams.
Report and Appeal Rights provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022

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

LIC9099 (FAS) - (06/04)

Page: 1 of 5

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
07/26/2022 and conducted by Evaluator Indira Loza

PUBLIC

COMPLAINT CONTROL NUMBER: 02-CC-20220726105748

FACILITY NAME:	YMCA EASTLAKE CENTER		FACILITY NUMBER:	013423040
ADMINISTRATOR:	LOVETTE TRAMMEL		FACILITY TYPE:	850
ADDRESS:	1612-45TH AVE		TELEPHONE:	(510) 370-2966
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94601
CAPACITY:	60	CENSUS: 48	DATE:	09/07/2022
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Jessica Boataer & Monica Williams		TIME COMPLETED:	04:50 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Record Keeping - Staff did not record administering day care child's medication

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022

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 5

Control Number 02-CC-20220726105748

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: YMCA EASTLAKE CENTER	FACILITY NUMBER: 013423040
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/07/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/05/2022 Section Cited CCR 101226(e)(5)	1 2 3 4 5 6 7	The licensee shall develop and implement a written plan to record the administration of prescription and nonprescription medications and to inform the child's authorized representative daily when such medications have been given. This requirement was not met as evidenced by the interviews indicating that	1 2 3 4 5 6 7	Director shall develop a plan to ensure staff are recording the administration of medications to children. Submit plan to LPA Loza by 10/5/22 via email indira.loza@dss.ca.gov or by mail.
	8 9 10 11 12 13 14	the medication log was not fillied out by staff after administering the medication. This poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14
	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.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 5

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
07/26/2022 and conducted by Evaluator Indira Loza

COMPLAINT CONTROL NUMBER: 02-CC-20220726105748

FACILITY NAME:	YMCA EASTLAKE CENTER		FACILITY NUMBER:	013423040
ADMINISTRATOR:	LOVETTE TRAMMEL		FACILITY TYPE:	850
ADDRESS:	1612-45TH AVE		TELEPHONE:	(510) 370-2966
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94601
CAPACITY:	60	CENSUS: 48	DATE:	09/07/2022
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Jessica Boataer & Monica Williams		TIME COMPLETED:	04:50 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Personal Rights - Staff made inappropriate comments in the presnece of day care child

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On September 7, 2022 at 9:45AM, Licensing Program Analyst (LPA) Indira Loza and Licensing Program Manager (LPM) arrived unannounced on a complaint investigation inspection and met with Assistant Director Jessica Boataer. Later, Area Manager Monica Williams arrived.

LPA conducted interviews which revealed that staff made inappropriate comments. The preponderance of evidence standard has been met, therefore the above allegation is to be substantiated.

An exit interview was conducted with Area Manager Monica Williams.
Report and Appeal Rights provided.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022

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 5

Control Number 02-CC-20220726105748

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: YMCA EASTLAKE CENTER	FACILITY NUMBER: 013423040
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/07/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/05/2022 Section Cited CCR 101223(a)(1)	1 2 3 4 5 6 7	(1) To be accorded dignity in his/her personal relationships with staff and other persons. This requirement was not met as evidenced by interviews confirming that inappropriate comments were made in the presence of children. This poses a potential health and safety risk to children in care.	1 2 3 4 5 6 7	All staff shall watch the Personal Rights video on the CCLD webpage: ccld.ca.gov, and write a statement of what was learned. Director shall email the statements to: indira.loza@dss.ca.gov.
	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
	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.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022

LIC9099 (FAS) - (06/04)

Page: 5 of 5