010206139-10-28-2021-02-CC-LDYN-C8Q2MZ-20211112163158

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 010206139
Report Date: 10/28/2021
Date Signed: 10/28/2021 11:16:00 AM

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
08/25/2021 and conducted by Evaluator Phyllis Dyer

PUBLIC

COMPLAINT CONTROL NUMBER: 02-CC-20210825091505

FACILITY NAME:	OUSD - STONEHURST		FACILITY NUMBER:	010206139
ADMINISTRATOR:	OFELIA ASENCIOS-MENDOZA		FACILITY TYPE:	850
ADDRESS:	901 - 105TH AVENUE		TELEPHONE:	(510) 639-3382
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94603
CAPACITY:	72	CENSUS: 42	DATE:	10/28/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Kianga Lee		TIME COMPLETED:	11:25 AM

ALLEGATION(S):

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Personal Rights - Child sustained unexplained injuries while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst Lisa Dyer met with Director Kianga Lee to provide the results of the above allegation. Present today is the director, 9 staff and 42 preschool children.
It was alleged that a child sustained unexplained injuries while in care. Sometime during the child’s first day at the center, an injury was found on the child’s shoulder/neck area. Interviews were conducted. It was described as a rash or as a scratch.
The child did not have an Inspection for Illness when he arrived at the facility. Neither staff or the parents were able to determine exactly how, when and/or where the injury actually took place.
Although the allegation of a child sustained unexplained injuries while in care 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 results are Unsubstantiated. Exit interview conducted. Appeal rights were discussed and given. This report must be kept available for public review for 3 years. Notice of Site Visit was posted.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Phyllis Dyer
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021

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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