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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015700344
Report Date: 07/27/2023
Date Signed: 07/27/2023 10:53:30 AM

Unsubstantiated


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
07/12/2023 and conducted by Evaluator Elimika Woods
COMPLAINT CONTROL NUMBER: 52-CC-20230712154934
FACILITY NAME:RODRIGUEZ, YSABELFACILITY NUMBER:
015700344
ADMINISTRATOR:YSABEL RODRIGUEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 677-4778
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY:14CENSUS: 2DATE:
07/27/2023
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Ysabel RodriguezTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Personal Rights-Day care child sustained unexplained injuries while in care
INVESTIGATION FINDINGS:
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On July 27, 2023 at 8:15 AM Licensing Program Analysts (LPA) Elimika Woods conducted an unannounced inspection to conclude a complaint investigation and met with the facility licensee, Ysabel Rodriguez and advised her the purpose of the inspection. There was one preschool age child, one infant and the licensee's fingerprint cleared assistant, I. Rodriguez The facility was toured inside and out by the LPA and representative.

LPA conducted interviews with the licensee and parents regarding the allegations that a day care child sustained unexplained injuries while in care. LPA also spoke with parents who said that they think the child fell out of a baby walker.

Based on the interviews and observations conducted, this agency has investigated the complaint alleging that a day care child sustained unexplained injuries while in care, 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.

This report shall remain on file for 3 years. A Notice of Site Visit was provided and must remain posted for 30 days and appeal rights provided. Exit interview conducted with licensee,Ysabel Rodriguez

Unsubstantiated
Estimated Days of Completion: 5
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023
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 7
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
07/12/2023 and conducted by Evaluator Elimika Woods
COMPLAINT CONTROL NUMBER: 52-CC-20230712154934

FACILITY NAME:RODRIGUEZ, YSABELFACILITY NUMBER:
015700344
ADMINISTRATOR:YSABEL RODRIGUEZFACILITY TYPE:
810
ADDRESS:584 WILLOW AVETELEPHONE:
(510) 677-4778
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY:14CENSUS: 2DATE:
07/27/2023
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Ysabel RodriguezTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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2
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9
Other-Licensee utilized a baby walker for day care child
INVESTIGATION FINDINGS:
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On July 27, 2023 at 8:15 AM Licensing Program Analysts (LPA) Elimika Woods conducted an unannounced inspection to conclude a complaint investigation and met with the facility representative, Ysabel Rodriguez and advised her the purpose of the inspection. There was one preschool age child, one infant and the licensee's fingerprint cleared assistant, I. Rodriguez The facility was toured inside and out by the LPA and representative.

LPA conducted interviews with the licensee and parents regarding the allegations that the licensee utilized a baby walker for day care child.

Based on the interviews and observations conducted, this agency has investigated the complaint alleging that the licensee utilized a baby walker for day care child, the preponderance of evidence standard has been met, Therefore, the allegation is SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 is being cited on 9099-D page.

LPAs discussed with licensee the seriousness of the substantiated finding for this complaint. Exit interview was conducted, where this report, the deficiency, plan of correction, and appeal rights were discussed with licensee, Ysabel Rodriguez.

A notice of site visit was given and must remain posted for 30 days.


Substantiated
Estimated Days of Completion: 5
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 52-CC-20230712154934
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: RODRIGUEZ, YSABEL
FACILITY NUMBER: 015700344
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/27/2023
Section Cited
CCR
102417(g)(10)
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Operation of a Family Child Care Home -
A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Section 1596.846(b) and (c). A baby walker is defined as any article known as a "baby bouncer," "walker-jumper," "baby walker: or
any such similar article.
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Licensee has removed the baby walker from the facility.

Deficiency cleared at visit.
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This requirement is not met as evidenced by:
Based on observation, there was a baby walker was in the on limis area of the home hallway area, which poses a potential health and safety risk to children in care.
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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: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 7
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
07/12/2023 and conducted by Evaluator Elimika Woods
COMPLAINT CONTROL NUMBER: 52-CC-20230712154934

FACILITY NAME:RODRIGUEZ, YSABELFACILITY NUMBER:
015700344
ADMINISTRATOR:YSABEL RODRIGUEZFACILITY TYPE:
810
ADDRESS:584 WILLOW AVETELEPHONE:
(510) 677-4778
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY:14CENSUS: 2DATE:
07/27/2023
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Ysabel RodriguezTIME COMPLETED:
11:15 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Other-Licensee utilized car seat as a restraint device for day care child
INVESTIGATION FINDINGS:
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On July 27, 2023 at 8:15 AM Licensing Program Analysts (LPA) Elimika Woods conducted an unannounced inspection to conclude a complaint investigation and met with the facility representative, Ysabel Rodriguez and advised her the purpose of the inspection. There was one preschool age child, one infant and the licensee's fingerprint cleared assistant, I. Rodriguez The facility was toured inside and out by the LPA and representative.

LPA conducted interviews with the licensee and parents regarding the allegations that the licensee utilized a car seat as a restraint device for day care child. LPA also spoke with parents who said that licensee leaves children in their car seats.

Based on the interviews and observations conducted, this agency has investigated the complaint alleging that the licensee utilized a car seat as a restraint device for day care children, 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.

This report shall remain on file for 3 years. A Notice of Site Visit was provided and must remain posted for 30 days and appeal rights provided. Exit interview conducted with licensee,Ysabel Rodriguez

Unsubstantiated
Estimated Days of Completion: 5
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 7