013423590-9-1-2021-02-CC-LDYN-C6VBCJ-20210915005736

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 013423590
Report Date: 09/01/2021
Date Signed: 09/01/2021 05:25:09 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
06/17/2021 and conducted by Evaluator Phyllis Dyer

PUBLIC

COMPLAINT CONTROL NUMBER: 02-CC-20210617154720

FACILITY NAME:	HARDY, PEGGY & JACKSON, LAHOMA		FACILITY NUMBER:	013423590
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 2	DATE:	09/01/2021
		UNANNOUNCED	TIME BEGAN:	04:04 PM
MET WITH:	Lahoma Jackson		TIME COMPLETED:	05:35 PM

ALLEGATION(S):

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Personal Rights - Licensee yelled at a daycare child.

INVESTIGATION FINDINGS:

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LPA Dyer met with Licensee Lahoma Jackson at 4:04 p.m. to provide the results of the above allegation. The licensee, 1 infant and 1 preschool aged child are present. It was alleged that the licensee yelled at a daycare child.
Interviews disclosed that while the licensee was taking care of a day care child, she went to a gathering at a friend’s home. The parent was not aware of the trip. When the parent asked the child what they did that day, the child told the mother about the trip. The mother went back to the provider’s home to discuss the licensee taking the child away from the home without permission. Although it may have not been the licensee's intent, the child’s personal rights were violated during this conversation where the trip was discussed. Based on the LPA's interviews which were conducted and record review(s), the preponderance of evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12) are being cited on the attached LIC 9099D, and must be corrected by the due date. Exit interview conducted. Licensee received a copy of their appeal rights. This report must be kept available for public review for 3 years. Notice of site visit was posted at the time of the inspection and must remain posted for 30 days.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Phyllis Dyer
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021

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-20210617154720

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: HARDY, PEGGY & JACKSON, LAHOMA	FACILITY NUMBER: 013423590
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/01/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/22/2021 Section Cited CCR 102423(a)(1)	1 2 3 4 5 6 7	Personal Rights. Each child receiving services from a family child care home shall have certain rights…(1) To be treated with dignity in his/her personal relationships with staff and other persons.	1 2 3 4 5 6 7	Licensee will provide a written plan of action detailing the steps she will take to ensure that children’s personal rights are not violated, and children are treated with dignity at the facility.
	8 9 10 11 12 13 14	This requirement was not met as evidence by interview: licensee violated Child 1’s personal rights when yelling at the child (in front of her mother) regarding an outing away from the facility. This violation poses an immediate health risk to the Personal Rights of Children in Care.	8 9 10 11 12 13 14	Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
	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: Phyllis Dyer
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021

LIC9099 (FAS) - (06/04)

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