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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013423926
Report Date: 06/24/2025
Date Signed: 06/24/2025 01:48:43 PM

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
04/01/2025 and conducted by Evaluator Tasha Hackett-Alexander
COMPLAINT CONTROL NUMBER: 02-CC-20250401141101
FACILITY NAME:EMBREY, TIARAFACILITY NUMBER:
013423926
ADMINISTRATOR:TIARA EMBREYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 692-1852
CITY:OAKLANDSTATE: CAZIP CODE:
94605
CAPACITY:12CENSUS: DATE:
06/24/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:TIME COMPLETED:
11:30 AM
ALLEGATION(S):
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9
CRIMINAL RECORD CLEARANCE- Uncleared adults in the facility
INVESTIGATION FINDINGS:
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13
This report is delivering the findings to a complaint filed against the facility.

Complainant alleges that uncleared adults cared for day care children. During course of investigation, LPA conducted interviews, facility inspection, reviewed records and obtained relevant documents. It was determined that a person named Risha was present in the facility on multiple occasions and provided supervision and care to day care children. Risha does not have a criminal background clearance and is not associated to the license.

Type A violation is cited as this posed an immediate Health & Safety risk to children in care. Based on information & evidence obtained, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 & Chapter 1, are being cited on the attached LIC. 9099D.

Citation is cleared today as facility has ceased day care operations and is permanently closed as of June 9, 2025. Licensee is unable to sign or receive the reports. This report and letter of clearance will be mailed to faciltiy address on file.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Monica Mathur
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2025
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-20250401141101
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: EMBREY, TIARA
FACILITY NUMBER: 013423926
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/25/2025
Section Cited
CCR
102416(d)(1)
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102416 Personnel Requirements
(d) Prior to employment or initial presence in the child care home, all employees and volunteers subject to a criminal record review shall:
(1) Obtain a California clearance or a criminal record exemption as required by law or Department regulations
THIS REQUIREMENT WAS NOT MET AS EVIDENCED BY
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The citation is cleared today, as facility has ceased day care operations and is permanently closed as of 6/9/2025. Letter of clearance is issued.
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Based on interviews and information, adult Risha was present at the facility on multiple occasions providing supervision & care to day care children, does not have criminal background clearance & is not associated to the facility. This posed an immediate risk to children in care.
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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: Monica Mathur
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
04/01/2025 and conducted by Evaluator Tasha Hackett-Alexander
COMPLAINT CONTROL NUMBER: 02-CC-20250401141101

FACILITY NAME:EMBREY, TIARAFACILITY NUMBER:
013423926
ADMINISTRATOR:TIARA EMBREYFACILITY TYPE:
810
ADDRESS:2515 64TH AVETELEPHONE:
(510) 692-1852
CITY:OAKLANDSTATE: CAZIP CODE:
94605
CAPACITY:12CENSUS: DATE:
06/24/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:TIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
PERSONAL RIGHTS-Licensee does not ensure facility is free from conditions which might endanger a child
INVESTIGATION FINDINGS:
1
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3
4
5
6
7
8
9
10
11
12
13
This report delivering the findings to a complaint filed against the facility.

Complainant alleges licensee does not ensure facility is free from conditions which might endanger a child. During course of investigation, LPA conducted interviews, facility inspection, reviewed records and obtained relevant documents. Based on video evidence obtained, some altercations between licensee and other adults did not take place at the facility, but at a different location. However CCL is unable to determine if any other similar incidents occured at the facility during day care hours or not.

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.

Facility has ceased day care operations and is permanently closed as of June 9, 2025. Licensee is unable to sign or receive reports. This report will be mailed to facility address on file.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Monica Mathur
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3