010205830-9-5-2024-02-CC-SJON-D9DMFN-20240923093437

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 010205830
Report Date: 09/05/2024
Date Signed: 09/05/2024 02:52:06 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
07/10/2024 and conducted by Evaluator Diana Campos

COMPLAINT CONTROL NUMBER: 02-CC-20240710111701

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:	09/05/2024
		UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Sandra Phelps		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility has mold.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

LPAs J. Vargas and D. Campos met with Center Director Sandra Phelps for a complaint investigation regarding the above allegation. Present were 4 staff and 13 preschool children in care. It was alleged that the facility has mold. During the course of the investigation, interviews and observations were conducted and pertinent records reviewed. LPAs did not observe signs of mold nor detect any mildew odor. Per center Director the facility had the carpet tested for mold on 2/24/24 where no mold was detected. Additionally, the facility had an environmental investigation conducted on 7/25/24 which concluded that there was no evidence of immediate health risks to current occupants. Although third party testing conducted did not confirm signs of mold in the classroom, another party reported concerns regarding mold in the facility. Based on the investigative findings, there was no evidence to determine whether or not facility has mold. 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.
Notice of Site Visit 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: 09/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

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 1