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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013423731
Report Date: 09/18/2024
Date Signed: 09/18/2024 10:36:29 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 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
04/16/2024 and conducted by Evaluator Diana Campos
COMPLAINT CONTROL NUMBER: 02-CC-20240416125249
FACILITY NAME:WILMA CHAN CHILD DEVELOPMENT CENTERFACILITY NUMBER:
013423731
ADMINISTRATOR:LUIS ARENASFACILITY TYPE:
830
ADDRESS:7980 PLYMOUTH STREETTELEPHONE:
(510) 535-6949
CITY:OAKLANDSTATE: CAZIP CODE:
94621
CAPACITY:16CENSUS: 7DATE:
09/18/2024
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Nicole GibbsTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Personal Rights- Staff handled day care child in a rough manner causing injury.
INVESTIGATION FINDINGS:
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LPA Diana Campos met with Center Director Nicole Gibbs to deliver the findings of a complaint investigation conducted by Special Investigator Victoria McIntosh of the Bureau of Investigations. Present during the investigation were 7 children and 5 staff.
An incident occurred when a teacher moving a child resulted in an injury. Although it may not have been the teacher’s intent to harm the child, interviews revealed teacher was observed grabbing child by the arm and lifting her, resulting in a nursemaid’s elbow injury. The incident was self reported to CCL.
Based on interviews conducted and records review, 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), are being cited on the attached LIC 9099D.
Exit interview conducted and report reviewed with Center Director Nicole Gibbs.
Notice of Site Visit provided must be posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024
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 3
Control Number 02-CC-20240416125249
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: WILMA CHAN CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 013423731
VISIT DATE: 09/18/2024
NARRATIVE
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LPA D. Campos informed Director Nicole Gibbs that this report dated 9/18/2024 documents 1 Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Diana Campos informed the Director Nicole Gibbs to provide a copy of this licensing report dated 09/18/2024 that documents any 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.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 02-CC-20240416125249
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 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: 09/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/19/2024
Section Cited
CCR
1012239(a)(3)
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Personal Rights. Each child shall be free from corporal or unusual punishment, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature.
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By 09/19/2024, a written plan of action will be submitted detailing steps staff will take to ensure children's personal rights are not violated. Additionally training on how to properly lift a child without hurting or violating their personal rights must be given to all staff.
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This requirement was not met as evidenced by: Staff grabbed child by the arm resulting in nursemaid’s elbow injury which is an immediate health and safety risk to persons in care.
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LPA is requesting additional team building training to strengthen staff relationships.
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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.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3