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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015700326
Report Date: 08/29/2023
Date Signed: 08/29/2023 02:13:49 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/24/2023 and conducted by Evaluator Briana Plumboy
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20230824100946

FACILITY NAME:ALANIZ, GABRIELA & ROMERO CAMPOS, JORGEFACILITY NUMBER:
015700326
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:5CENSUS: 5DATE:
08/29/2023
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Gabriela Alaniz- LicenseeTIME COMPLETED:
02:25 PM
ALLEGATION(S):
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Ratio- Facility is out of ratio
INVESTIGATION FINDINGS:
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On 8/29/23 at 1:15pm, LPA Plumboy met with licensee Gabriela Alaniz for a complaint investigation regarding the above allegation. Present during the inspection was 5 infants in care. LPA advised licensee Gabriela Alaniz the nature of the complaint, toured the facility, conducted a census, and received a copy of the roster.
The allegation that the licensee is out of ratio has been SUBSTANTIATED. Based on LPA's observations and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Title 22, Division 12, Chapter 1, Section 102416.5(a) is being cited on the attached LIC. 9099D.
LIC 9224 was issued and discussed.
A notice of site visit was given and must remain posted for 30 days.
Appeal Rights were given and discussed. An exit interview was conducted.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023
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 52-CC-20230824100946
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ALANIZ, GABRIELA & ROMERO CAMPOS, JORGE
FACILITY NUMBER: 015700326
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/29/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/30/2023
Section Cited
CCR
102416.5(a)
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102416.5(a) Staffing Ratio and Capacity. The capacity specified on the license shall be the maximum number of children for whom care can be provided.
THE LICENSEE IS OUT OF RATIO TODAY. WHEN LPA PLUMBOY ARRIVED AT THE FACILITY, THERE WERE
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Licensee is to reduce numbers to within capacity specified on license by 8/30/23. LPA to revisit to ensure Licensee is remaining within ratio.
Licensee will watch the ratio/capacity video on the ccld.ca.gov website and submit a summary to LPA Plumboy via email.
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5 INFANTS IN CARE WITH LICENSEE ALONE. LPA PLUMBOY DISCUSSED THE AGE REQUIREMENTS TO STAY IN COMPLIANCE WITH RATIO. WHEN A FACILTY IS OUT OF RATIO, THIS POSES AN IMMEDIATE RISK TO CHILDREN IN CARE.
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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.
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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: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023
LIC9099 (FAS) - (06/04)
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