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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 010206131
Report Date: 03/30/2023
Date Signed: 03/30/2023 01:46:22 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
09/07/2022 and conducted by Evaluator Ashley Curry
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20220907121056
FACILITY NAME:OUSD - HINTIL KUU CAFACILITY NUMBER:
010206131
ADMINISTRATOR:JONES, CAROLINEFACILITY TYPE:
850
ADDRESS:11850 CAMPUS DRIVETELEPHONE:
(510) 879-0840
CITY:OAKLANDSTATE: CAZIP CODE:
94619
CAPACITY:42CENSUS: 18DATE:
03/30/2023
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Sharon TraversTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Day care child was sexually abused while in care.
Facility did not inform authorized representative of incident.
INVESTIGATION FINDINGS:
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On 03/30/2023 at 1:30 PM Licensing Program Analyst (LPA) A. Curry conducted an unannounced complaint inspection to deliver the findings to the above allegations. The investigation Bureau investigated the complaint and conducted interviews. The allegations are day care child was sexually abused while in care and facility did not inform authorized representative of incident. Based on the information provided, it could not be determined if the allegations happened or is valid. There is not a preponderance of evidence to prove that the alleged violations did or did not occur. Therefore the above allegations are Unsubstantiated.

An exit interview was conducted, appeal rights were given, and report was reviewed with the site principal Sharon Travers.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023
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 3
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
09/07/2022 and conducted by Evaluator Ashley Curry
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20220907121056

FACILITY NAME:OUSD - HINTIL KUU CAFACILITY NUMBER:
010206131
ADMINISTRATOR:JONES, CAROLINEFACILITY TYPE:
850
ADDRESS:11850 CAMPUS DRIVETELEPHONE:
(510) 879-0840
CITY:OAKLANDSTATE: CAZIP CODE:
94619
CAPACITY:42CENSUS: DATE:
03/30/2023
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Sharon TraversTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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9
Facility did not report to CCL.
INVESTIGATION FINDINGS:
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On 03/30/2023 at 1:30PM Licensing Program Analyst (LPA) A. Curry conducted an unannounced complaint inspection to the deliver the finding to the above allegation. The Investigation Bureau investigated the complaint and conducted interviews. The allegation is facility did not report to CCL. Information obtained during interviews, indicated the licensee was informed on 09/12/2022 and did not report to Licensing until 09/15/2022. The facility is required to notify the Department within the Department’s next working day and during its normal business hours of any unsual incidents. Based on the interviews and record review the preponderance of evidence standard has been met. Therefore the above allegation is found to be SUBSTANTIATED.

An exit interview was conducted, appeal rights were given, and report was reviewed with the site principal Sharon Travers.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023
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 3
Control Number 02-CC-20220907121056
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: OUSD - HINTIL KUU CA
FACILITY NUMBER: 010206131
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/28/2023
Section Cited
CCR
101212(d)(1)(C)
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101212Reporting Requirements (d) Upon the occurrence....a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in... (C) Any unusual incident...that threatens the physical or emotional health or safety of any child.
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By 04/28/2023 the site principal will watch the Reporting Requirements Video at www.ccld.ca.gov and submit a brief summary of the video.
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This Requirement was not met as evidence by:

Based on interviews and record review, the licensee did not report an unusual incident to the Department within the next working day, which poses a potential risk to the health, safety, and personal rights to children in care.
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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: Ashley Curry
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3