013423731-8-6-2024-02-CC-SJON-D8T44D-20240904184606

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 013423731
Report Date: 08/06/2024
Date Signed: 08/06/2024 05:02:28 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
06/04/2024 and conducted by Evaluator Diana Campos

COMPLAINT CONTROL NUMBER: 02-CC-20240604174026

FACILITY NAME:	WILMA CHAN CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	013423731
ADMINISTRATOR:	LUIS ARENAS		FACILITY TYPE:	830
ADDRESS:	7980 PLYMOUTH STREET		TELEPHONE:	(510) 535-6949
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94621
CAPACITY:	16	CENSUS: 0	DATE:	08/06/2024
		UNANNOUNCED	TIME BEGAN:	03:09 PM
MET WITH:	Nicole Gibbs		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Day-care child was left in a classroom unattended.

INVESTIGATION FINDINGS:

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LPA D. Campos met with Center Director Nicole Gibbs for a complaint investigation regarding the above allegation. Present today upon LPA's arrival, there were 8 staff members. No children were present during today's inspection. During the course of the investigation, interviews were conducted and pertinent records reviewed. An incident occurred when a child was found by a teacher alone without adult supervision. A review of records revealed that the facility reported the incident to the licensing office the following day as well as to the parent immediately following incident.
Based on the 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 & Chapter Number (101416.5)), are being cited on the attached LIC 9099D.

Exit interview conducted and report reviewed with Director Nicole Gibbs.
A site visit notice was posted by Director.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024

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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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
06/04/2024 and conducted by Evaluator Diana Campos

COMPLAINT CONTROL NUMBER: 02-CC-20240604174026

FACILITY NAME:	WILMA CHAN CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	013423731
ADMINISTRATOR:	LUIS ARENAS		FACILITY TYPE:	830
ADDRESS:	7980 PLYMOUTH STREET		TELEPHONE:	(510) 535-6949
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94621
CAPACITY:	16	CENSUS: 0	DATE:	08/06/2024
		UNANNOUNCED	TIME BEGAN:	03:09 PM
MET WITH:	Nicole Gibbs		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff handled day-care child in a rough manner.

INVESTIGATION FINDINGS:

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3
4
5
6
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LPA D. Campos met with center Director Nicole Gibbs for a complaint investigation regarding the above allegation. Present upon LPA's arrival were 8 staff. No children were present during this investigation. It was alleged that staff handled day-care child in a rough manner. During the course of the investigation, interviews were conducted and facility records reviewed. Children's personal rights were discussed. Based on the investigative findings, there was no evidence to determine whether or not staff handled day-care child in a rough manner. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. Therefore, the allegation is unsubstantiated at this time.

Exit interview conducted and report reviewed with Director Nicole Gibbs.
Notice of Site Visit provided must remain posted for 30 days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024

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-20240604174026

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: WILMA CHAN CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 013423731
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/06/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/13/2024 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time,	1 2 3 4 5 6 7	Center Director reported the incident to the licensing office and notified the parent. Facility conducted an internal investigation and corrective action was taken. By the POC date Facility shall conduct active supervision training and submit to LPA copies of training material as well as a signature log of all attending staff.
	8 9 10 11 12 13 14	except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement was not met as evidenced by: A child was found by a staff alone without adult supervision and facility self reported incident to the licensing office.	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: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024

LIC9099 (FAS) - (06/04)

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