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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013423128
Report Date: 07/18/2024
Date Signed: 07/18/2024 05:03:52 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
06/13/2024 and conducted by Evaluator Indira Loza
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20240613134755
FACILITY NAME:SMALLTRANS BEARSFACILITY NUMBER:
013423128
ADMINISTRATOR:JACKSON-BURNS, CYNTHIAFACILITY TYPE:
830
ADDRESS:111 GRAND AVENUETELEPHONE:
(510) 286-5130
CITY:OAKLANDSTATE: CAZIP CODE:
94612
CAPACITY:40CENSUS: 0DATE:
07/18/2024
UNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Cynthia Jackson-BurnsTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights: Staff is abusing day care children
Children are being left alone as punishment
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On July 18, 2024 at 2:10pm, Licensing Program Analyst (LPA) Indira Loza and Licensing Program Managers (LPMs) Mayla Mendoza and Sherelle Johnson arrived unannounced to deliver the findings to the above allegation. There were no children or staff present during today's visit. LPA delivered the findings to Licensee/Director Cynthia Jackson-Burns via telephone. During the course of the investigation LPAs Loza and Fernandes conducted interviews with parents, staff, and children, observed the classrooms, reviewed center documentation regarding the allegation and did a walkthrough of the center.

Interviews stated that staff members at the center were verbally and physically abusing the children in care, which included hitting, pushing, pulling, and calling the children inappropriate names. Interviews also stated that that children have been left alone in the office and the toddler bathroom as punishment when not behaving or when crying. The preponderance of evidence standard has been met, therefore the allegation is SUBSTANTIATED. California Code of Regulations, Title 22 101223(a)(3) is being cited on the attached LIC9099-D with a Type A citation.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
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 11
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
06/13/2024 and conducted by Evaluator Indira Loza
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20240613134755

FACILITY NAME:SMALLTRANS BEARSFACILITY NUMBER:
013423128
ADMINISTRATOR:JACKSON-BURNS, CYNTHIAFACILITY TYPE:
830
ADDRESS:111 GRAND AVENUETELEPHONE:
(510) 286-5130
CITY:OAKLANDSTATE: CAZIP CODE:
94612
CAPACITY:40CENSUS: 0DATE:
07/18/2024
UNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Cynthia Jackson-BurnsTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Criminal Record Clearance - Staff are not fingerprinted
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On July 18, 2024 at 2:10pm, Licensing Program Analyst (LPA) Indira Loza and Licensing Program Managers (LPMs) Mayla Mendoza and Sherelle Johnson arrived unannounced to deliver the findings to the above allegation. There were no children or staff present during today's visit. LPA delivered the findings to Licensee/Director Cynthia Jackson-Burns via telephone. During the course of the investigation LPAs Loza and Fernandes conducted interviews with parents, staff, and children, observed the classrooms, reviewed center documentation regarding the allegation and did a walkthrough of the center.

Interviews and documentation provided to the LPAs confirmed that a staff member was not cleared prior to being in the presence of children in care. The preponderance of evidence standard has been met, therefore the allegation is SUBSTANTIATED. California Code of Regulations, Title 22 101170(e) is being cited on the attached LIC9099-D with a Type A citation and a $500 civil penalty.


Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
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 11
Control Number 02-CC-20240613134755
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: SMALLTRANS BEARS
FACILITY NUMBER: 013423128
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/19/2024
Section Cited
CCR
101170(e)(1)
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2
3
4
5
6
7
Criminal Record Clearance All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility. (1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement has not been met as evidenced by:
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2
3
4
5
6
7
TSO has been issued and licensee has been advised of her appeal rights.
8
9
10
11
12
13
14
Based on interviews and pictures, Kayla Humphreys worked and provided care to children prior to having a criminal background clearance, which is an immediate risk to the health, safety, and personal rights of children in care.
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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.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 11
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
06/13/2024 and conducted by Evaluator Indira Loza
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20240613134755

FACILITY NAME:SMALLTRANS BEARSFACILITY NUMBER:
013423128
ADMINISTRATOR:JACKSON-BURNS, CYNTHIAFACILITY TYPE:
830
ADDRESS:111 GRAND AVENUETELEPHONE:
(510) 286-5130
CITY:OAKLANDSTATE: CAZIP CODE:
94612
CAPACITY:40CENSUS: 0DATE:
07/18/2024
UNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Cynthia Jackson-BurnsTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Qualifications - Staff are not fully qualified
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On July 18, 2024 at 2:10pm, Licensing Program Analyst (LPA) Indira Loza and Licensing Program Managers (LPMs) Mayla Mendoza and Sherelle Johnson arrived unannounced to deliver the findings to the above allegation. There were no children or staff present during today's visit. LPA delivered the findings to Licensee/Director Cynthia Jackson-Burns via telephone. During the course of the investigation LPAs Loza and Fernandes conducted interviews with parents, staff, and children, observed the classrooms, reviewed center documentation regarding the allegation and did a walkthrough of the center.

According to the teacher transcripts provided by Cynthia Jackson-Burns, two of the three teachers are not qualified as infant teachers. The preponderance of evidence standard has been met, therefore the allegation is SUBSTANTIATED. California Code of Regulations, Title 22 101416.2(c)(1)(A) is being cited on the attached LIC9099-D with a Type A citation.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
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 11
Control Number 02-CC-20240613134755
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: SMALLTRANS BEARS
FACILITY NUMBER: 013423128
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/19/2024
Section Cited
CCR
101416.2(c)(1)(A)
1
2
3
4
5
6
7
Infant Care Teacher Qualifications and Duties- To be a fully qualified infant care teacher, a teacher shall have the following: (c) To be a fully qualified infant care teacher, a teacher shall have the following: (1) Completion, with passing grades, of 12 postsecondary semester or equivalent quarter units in early childhood or child development education at an accredited or approved college or university. (A) At least three of the units required in (c)(1) above shall be related to the care of infants or shall contain instruction specific to infants. This requirement has not been met as evidenced by:
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2
3
4
5
6
7
TSO has been issued and licensee has been advised of her appeal rights.
8
9
10
11
12
13
14
Based on the provided transcripts two of the three teachers are not qualified as infant teachers, which is an immediate risk to the health, safety, and personal rights of 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.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 11
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
06/13/2024 and conducted by Evaluator Indira Loza
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20240613134755

FACILITY NAME:SMALLTRANS BEARSFACILITY NUMBER:
013423128
ADMINISTRATOR:JACKSON-BURNS, CYNTHIAFACILITY TYPE:
830
ADDRESS:111 GRAND AVENUETELEPHONE:
(510) 286-5130
CITY:OAKLANDSTATE: CAZIP CODE:
94612
CAPACITY:40CENSUS: 0DATE:
07/18/2024
UNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Cynthia Jackson-BurnsTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Admission Procedures and Parental and Authorized Representative's Rights - Parents not allowed in facility
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On July 18, 2024 at 2:10pm, Licensing Program Analyst (LPA) Indira Loza and Licensing Program Managers (LPMs) Mayla Mendoza and Sherelle Johnson arrived unannounced to deliver the findings to the above allegation. There were no children or staff present during today's visit. LPA delivered the findings to Licensee/Director Cynthia Jackson-Burns via telephone. During the course of the investigation LPAs Loza and Fernandes conducted interviews with parents, staff, and children, observed the classrooms, reviewed center documentation regarding the allegation and did a walkthrough of the center.

Interviews stated that some parents were denied entry to the day care center and a posted document at the entrance of the day care confirms that Owner/Director Cynthia did not allow parents in the day care without prior authorization. The preponderance of evidence standard has been met, therefore, the allegation is SUBSTANTIATED. California Code of Regulations, Title 22 101218(b)(1) is being cited on the attached LIC9099-D with a Type B citation.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 11
Control Number 02-CC-20240613134755
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: SMALLTRANS BEARS
FACILITY NUMBER: 013423128
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/19/2024
Section Cited
CCR
101218.1(b)(1)
1
2
3
4
5
6
7
 Admission Procedures and Parental and Authorized Representative's Rights (b) At the time of acceptance of each child in care, the licensee shall inform each child's parent or authorized representative of his/her rights that include, but are not limited to, the following: (1) To enter and inspect the child care center in accordance with Health and Safety Code Section 1596.857. This requirement has not been met as evidenced by:
1
2
3
4
5
6
7
TSO has been issued and licensee has been advised of her appeal rights.
8
9
10
11
12
13
14
Based on interviews parents were not allowed in the center and some parents were denied entry when requested, which is a potential risk to the health, safety, and personal rights of 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.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 7 of 11
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
06/13/2024 and conducted by Evaluator Indira Loza
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20240613134755

FACILITY NAME:SMALLTRANS BEARSFACILITY NUMBER:
013423128
ADMINISTRATOR:JACKSON-BURNS, CYNTHIAFACILITY TYPE:
830
ADDRESS:111 GRAND AVENUETELEPHONE:
(510) 286-5130
CITY:OAKLANDSTATE: CAZIP CODE:
94612
CAPACITY:40CENSUS: 0DATE:
07/18/2024
UNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Cynthia Jackson-BurnsTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Buildings and Grounds - Facility is in disrepair
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On July 18, 2024 at 2:10pm, Licensing Program Analyst (LPA) Indira Loza and Licensing Program Managers (LPMs) Mayla Mendoza and Sherelle Johnson arrived unannounced to deliver the findings to the above allegation. There were no children or staff present during today's visit. LPA delivered the findings to Licensee/Director Cynthia Jackson-Burns via telephone. During the course of the investigation LPAs Loza and Fernandes conducted interviews with parents, staff, and children, observed the classrooms, reviewed center documentation regarding the allegation and did a walkthrough of the center.

Interviews stated there was an ongoing leak in the kitchen caused by the washer that was not repaired in a timely manner. The preponderance of evidence standard has been met, therefore, the allegation is SUBSTANTIATED. California Code of Regulations, Title 22 101238(a) is being cited on the attached LIC9099-D with a Type B citation.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 8 of 11
Control Number 02-CC-20240613134755
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: SMALLTRANS BEARS
FACILITY NUMBER: 013423128
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/19/2024
Section Cited
CCR
101238(a)
1
2
3
4
5
6
7
Buildings and Grounds -The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement has not been met as evidenced by:
1
2
3
4
5
6
7
TSO has been issued and licensee has been advised of her appeal rights.
8
9
10
11
12
13
14
Based on interviews, there was a leak in the center that was not taken care of in timely manner, which is a potential risk to the health, safety, and personal rights of 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.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 9 of 11
Control Number 02-CC-20240613134755
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: SMALLTRANS BEARS
FACILITY NUMBER: 013423128
VISIT DATE: 07/18/2024
NARRATIVE
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32
LPA Loza  informed Licensee Cynthia Jackson-Burns that this report dated July 18, 2024 document(s) 3Type A citation(s) which shall be posted for 30 consecutive days as there are immediate risk(s) to the health, safety, or personal rights of children in care. 

Also, LPA Loza informed the licensee to provide a copy of this licensing report dated  July 18, 2024 that documents the Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.  

Exit Interview conducted.
Report and Appeal Rights provided to Licensee/Director Cynthia Jackson-Burns via telephone.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 10 of 11
Control Number 02-CC-20240613134755
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: SMALLTRANS BEARS
FACILITY NUMBER: 013423128
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/19/2024
Section Cited
CCR
101223(a)(3)
1
2
3
4
5
6
7
Personal Rights: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning. This requirement has not been met as evidenced by:
1
2
3
4
5
6
7
TSO has been issued and licensee has been advised of her appeal rights.
8
9
10
11
12
13
14
Based on interviews, staff members were hitting, pushing, pulling, yelling, intimidating, calling the children inappropriate names while in care, and staff have left children in the director’s office and in the toddler bathroom as punishment for misbehaving or crying, which is an immediate risk to the health, safety, and personal rights of children in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
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7
1
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7
1
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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) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
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