010205830-4-15-2024-02-CC-SJON-D5GP9L-20240521110715

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 010205830
Report Date: 04/15/2024
Date Signed: 04/15/2024 01:21:54 PM

Unsubstantiated

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
04/10/2024 and conducted by Evaluator Diana Campos

PUBLIC

COMPLAINT CONTROL NUMBER: 02-CC-20240410100128

FACILITY NAME:	AGNES MEMORIAL		FACILITY NUMBER:	010205830
ADMINISTRATOR:	SANDRA PHELPS		FACILITY TYPE:	850
ADDRESS:	2372 INTERNATIONAL BLVD		TELEPHONE:	(510) 533-1101
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94601
CAPACITY:	24	CENSUS: 13	DATE:	04/15/2024
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Sandra Phelps		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff did not accord child dignity in their relationship with staff or other persons.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA's) M. Mathur and D. Campos conducted an unannounced complaint inspection to investigate the above allegation. LPA's met with the Director Sandra Phelps. Present at the facility during the investigation were 4 fingerprint cleared staff, and 13 preschool children in care.
During the course of the investigation, interviews and observations were conducted.
It was alleged that staff did not accord child dignity in their relationship with staff or other persons. Based on the investigative findings, there was no evidence to determine whether or not the allegation happened. 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 at this time.

Exit interview conducted and report reviewed with Director Sandra Phelps.
Notice of Site provided must remain posted for 30 days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024

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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