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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073408944
Report Date: 06/20/2024
Date Signed: 06/20/2024 04:15:48 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
06/13/2024 and conducted by Evaluator Diana Campos
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20240613173355
FACILITY NAME:YMCA OF THE EAST BAY - LONE TREE ELCFACILITY NUMBER:
073408944
ADMINISTRATOR:SHAMAICA WALKERFACILITY TYPE:
850
ADDRESS:1931 MOKELUMNE DRIVETELEPHONE:
(925) 644-6116
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:57CENSUS: 27DATE:
06/20/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Shamaica WalkerTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Neglect/Lack of Supervision-Staff left a child in care unattended.
INVESTIGATION FINDINGS:
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LPA Diana Campos met with Center Director Shamaica Walker for a complaint investigation regarding the above allegation. Present today upon LPA's arrival, were 11 staff members and 27 children in care. During the investigation, interviews were conducted and a copy of the children's roster and personnel report were obtained. Interviews revealed that a day care child was found by a staff member sitting in the outdoor play area alone without adult supervision for an undetermined period of time.
Based on the LPA's interviews which were conducted , 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 Shamaica Walker.

A Notice of Site Visit was provided and must remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024
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-20240613173355
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: YMCA OF THE EAST BAY - LONE TREE ELC
FACILITY NUMBER: 073408944
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/21/2024
Section Cited
CCR
101229(a)(1)
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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, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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Director shall submit by the POC due date a plan of action describing how the facility will ensure this incident does not repeat.
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This requirement has not been met as evidenced by information obtained confirming that a child in care was found alone in the outdoor play area without adult supervision, which poses an immediate risk to the health and safety of children in care.
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Director will hold a meeting with staff to discuss the importance of supervision. director will send sign in sheet for those in attendance, as well as the minutes of the meeting. Director will email documents to LPA Diana Campos.
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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: 06/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 02-CC-20240613173355
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: YMCA OF THE EAST BAY - LONE TREE ELC
FACILITY NUMBER: 073408944
VISIT DATE: 06/20/2024
NARRATIVE
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LPA informed Director Shamaica Walker that this report dated 6/20/24 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA informed the Director to provide a copy of this licensing report dated 6/20/24 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: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3