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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 010205830
Report Date: 12/12/2023
Date Signed: 12/12/2023 05:36:44 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
10/17/2023 and conducted by Evaluator Diana Campos
COMPLAINT CONTROL NUMBER: 02-CC-20231017144336
FACILITY NAME:AGNES MEMORIALFACILITY NUMBER:
010205830
ADMINISTRATOR:SANDRA PHELPSFACILITY TYPE:
850
ADDRESS:2372 INTERNATIONAL BLVDTELEPHONE:
(510) 533-1101
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY:24CENSUS: 13DATE:
12/12/2023
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Sandra PhelpsTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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8
9
Facility lacks fully qualified teachers
INVESTIGATION FINDINGS:
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3
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5
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7
8
9
10
11
12
13
Licensing Program Analysts (LPA's) Cherie Acosta and Diana Campos met with Center Director Sandra Phelps for a complaint investigation regarding the above allegation. Present during the investigation were the center Director and 3 Teacher Assistants supervising 13 preschool children. During the course of the investigation, staff files and qualifications were reviewed. With the exception of the Director a review of records revealed that neither staff member had proof of being qualified teachers.
Based on the LPA's observations, interviews which were conducted and record review(s), 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 Center Director Sandra Phelps.
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: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023
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 9
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
10/17/2023 and conducted by Evaluator Diana Campos
COMPLAINT CONTROL NUMBER: 02-CC-20231017144336

FACILITY NAME:AGNES MEMORIALFACILITY NUMBER:
010205830
ADMINISTRATOR:SANDRA PHELPSFACILITY TYPE:
850
ADDRESS:2372 INTERNATIONAL BLVDTELEPHONE:
(510) 533-1101
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY:24CENSUS: 13DATE:
12/12/2023
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Sandra PhelpsTIME COMPLETED:
05:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff has flicked the ears and hands of children and spanked children
INVESTIGATION FINDINGS:
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2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPA's) Cherie Acosta and Diana Campos conducted an unannounced visit to investigate the above allegation. LPA's met with Center Director Sandra Phelps. Present during the investigation were the Director and 3 Teacher Aids supervising 13 preschool children. During the investigation LPA's received conflicting information. Although staff deny ever flicking or spanking a child, another party reported observing staff flick children on the ear and hand and spanking children.

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 deemed unsubstantiated.
Notice of Site Visit provided and must remain posted for 30 days. Exit interview conducted and report reviewed with Sandra Phelps
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023
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 9
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
10/17/2023 and conducted by Evaluator Diana Campos
COMPLAINT CONTROL NUMBER: 02-CC-20231017144336

FACILITY NAME:AGNES MEMORIALFACILITY NUMBER:
010205830
ADMINISTRATOR:SANDRA PHELPSFACILITY TYPE:
850
ADDRESS:2372 INTERNATIONAL BLVDTELEPHONE:
(510) 533-1101
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY:24CENSUS: 13DATE:
12/12/2023
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Sandra PhelpsTIME COMPLETED:
05:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Vehicle was not equipped with proper vehicle restraints for children
INVESTIGATION FINDINGS:
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2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPA's) Cherie Acosta and Diana Campos conducted an unannounced visit to investigate the above allegation. LPA's met with Center Director Sandra Phelps. Present during the investigation were the Director and 3 Teacher Aids supervising 13 preschool children. During the investigation interviews and observations were conducted. Although the transportation vehicle used by the facility is equipped with proper vehicle restraints today, another party reported that children were transported in vehicles without proper vehicle restraints.

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 deemed unsubstantiated.
Notice of Site Visit provided and must remain posted for 30 days. Exit interview conducted and report reviewed with Sandra Phelps
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 9 of 9
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
10/17/2023 and conducted by Evaluator Diana Campos
COMPLAINT CONTROL NUMBER: 02-CC-20231017144336

FACILITY NAME:AGNES MEMORIALFACILITY NUMBER:
010205830
ADMINISTRATOR:SANDRA PHELPSFACILITY TYPE:
850
ADDRESS:2372 INTERNATIONAL BLVDTELEPHONE:
(510) 533-1101
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY:24CENSUS: 13DATE:
12/12/2023
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Sandra PhelpsTIME COMPLETED:
05:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
facility is out of ratio
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPA's) Cherie Acosta and Diana Campos met with Center Director Sandra Phelps for a complaint investigation regarding the above allegation. Present during the investigation were the center Director and 3 Teacher Assistants supervising 13 preschool children. During the course of the investigation, interviews were conducted, staff files and qualifications were reviewed. With the exception of the Director a review of records revealed that none of the staff members have proof of being qualified teachers. Per LPA observation, on at least one ocasion, facility was out of ratio when Director assists children to the restroom.
Based on LPA's observations and record review(s), 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 Center Director Sandra Phelps.
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: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023
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 9
Control Number 02-CC-20231017144336
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: AGNES MEMORIAL
FACILITY NUMBER: 010205830
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/13/2023
Section Cited
HSC
101216.3(a)
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101216.3 teacher-child Ratio (a)There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below. This requirement was not met as evidenced by:
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By POC date, facility shall submit a plan of action on how they will ensure the facility remains in ratio at all times.
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14
This requirement was not met as evidenced by: On at least one occasion facility was out of ratio when Director, who is the only staff with teacher qualifications assists a child to the restroom.
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14
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5
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7
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3
4
5
6
7
1
2
3
4
5
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7
1
2
3
4
5
6
7
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: 12/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 9
Control Number 02-CC-20231017144336
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: AGNES MEMORIAL
FACILITY NUMBER: 010205830
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/13/2023
Section Cited
CCR
101216.1(b)(1)
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2
3
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7
101216.1 Teacher Qualifications and Duties
(b) Prior to employment, a teacher shall meet the requirements of (b)(1) or (b)(2) below:
(1) A teacher shall have completed, with passing grades, at least six postsecondary semester or equivalent quarter units of the education requirement specified in (c)(1) below, or shall have obtained a Child Development Assistance Permit issued by the California Commission on Teacher Credentialing.
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2
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By the POC date, facility shall submit a plan of action on how they will ensure facility will have qualified staff at all times.
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14
This requirement was not met as evidenced by: Per interviews and record review, with the exception of Director none of the staff present meet the teacher qualification requirements which poses an immediate risk to the health and safety of children in care.
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14
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7
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5
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7
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2
3
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5
6
7
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: 12/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 9