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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073409372
Report Date: 08/21/2023
Date Signed: 08/21/2023 10:57:01 AM

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
08/18/2023 and conducted by Evaluator Tasha Hackett-Alexander
COMPLAINT CONTROL NUMBER: 02-CC-20230818100710
FACILITY NAME:DOBOUE, MARIEFACILITY NUMBER:
073409372
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
08/21/2023
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:MARIE DOBOUETIME COMPLETED:
11:15 AM
ALLEGATION(S):
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LICENSE- Facility is operating out of ratio
INVESTIGATION FINDINGS:
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LICENSING PROGRAM ANALYST TASHA ALEXANDER MET WITH LICENSEE MARIE DOBOUE IN REGARDS TO THE ABOVE COMPLAINT ALLEGATION.

PRESENT FOR TODAY'S INSPECTION IS LICENSEE, HER 11 YEAR OLD SON AND 5 INFANTS IN CARE. TODAY AN OBSERVATION OF THE FAMILY CHILD CARE HOME AND AN INTERVIEW WITH LICENSEE WAS CONDUCTED.

BASED ON LPAs OBSERVATIONS AND INTERVIEWS WHICH WERE CONDUCTED AND RECORD REVIEWS, THE PREPONDERANCE OF EVIDENCE STANDARD HAS BEEN MET, THEREFORE 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

AN EXIT INTERVIEW WAS CONDUCTED. A NOTICE OF CITE VISIT WAS POSTED.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2023
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 02-CC-20230818100710
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: DOBOUE, MARIE
FACILITY NUMBER: 073409372
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/28/2023
Section Cited
CCR
102416.5(b)(1)(2)
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102416.5 Staffing Ratio and Capacity
(b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following:
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IMMEDIATELY LICENSEE WILL REDUCE THE AMOUNT OF INFANTS IN CARE BY 1. IF LICENSEE CARES FOR UP TO 4 INFANTS, NO OTHER CHILDREN WILL BE PRESENT. IF OLDER CHILDREN WILL BE IN CARE, LICENSEE WILL REDUCE THE AMOUNT OF INFANTS TO COMPLY WITH TITLE 22 REGULATIONS.
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(1) Four infants; or

(2) Six children, no more than three of whom may be infants; or

(3) More than six and up to eight children, without an additional adult attendant, only if the criteria in Section 1597.44 of the Health and Safety Code are met. TODAY UPON ARRIVAL THERE ARE 5 INFANTS IN CARE
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FAILURE TO COMPLY WILL RESULT IN A CIVIL PENALTY.
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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: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2023
LIC9099 (FAS) - (06/04)
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