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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 010206146
Report Date: 03/07/2024
Date Signed: 03/07/2024 12:10:47 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
02/16/2024 and conducted by Evaluator Ashley Curry
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20240216110102
FACILITY NAME:OUSD - MANZANITAFACILITY NUMBER:
010206146
ADMINISTRATOR:BIRDIE WINROWFACILITY TYPE:
850
ADDRESS:2618 GRANDE VISTA AVENUETELEPHONE:
(510) 879-0829
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY:79CENSUS: 34DATE:
03/07/2024
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Sharon TraversTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Facility failed to prevent child from receiving injury by another child in care.
INVESTIGATION FINDINGS:
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On 03/07/2024 at 8:45 AM Licensing Program Analyst (LPA), A. Curry conducted a subsequent complaint inspection. LPA met with the Site Principal, Sharon Travers, to discuss the above allegation. LPA toured the facility, retrieved documentation, reviewed files, and conducted interviews with staff. Although staff indicated they provided additional support to C1, staff did not prevent C1 from pulling C2's braid from C2's scalp. Based on the LPA’s interviews C2 was not accorded a safe enviornment, so the preponderance of evidence standard has been met. Therefore the above allegation is found to be SUBSTANTIATED. Violations of the California Code of Regulations, Title 22, Division 12, Section 101223(a)(2) is being cited on the attached LIC 9099D.

Exit interview 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: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
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 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
02/16/2024 and conducted by Evaluator Ashley Curry
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20240216110102

FACILITY NAME:OUSD - MANZANITAFACILITY NUMBER:
010206146
ADMINISTRATOR:BIRDIE WINROWFACILITY TYPE:
850
ADDRESS:2618 GRANDE VISTA AVENUETELEPHONE:
(510) 879-0829
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY:79CENSUS: 34DATE:
03/07/2024
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Sharon TraversTIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
facility staff is not meeting the needs of children in care.
INVESTIGATION FINDINGS:
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12
13
On 03/07/2024 at 8:45 AM Licensing Program Analyst (LPA), A. Curry conducted a subsequent complaint inspection. LPA met with the Site Principal, Sharon Travers, to discuss the above allegation. LPA toured the facility, retrieved documentation, reviewed files, and conducted interviews with staff. Based on information gathered through interviews, it could not be determined that staff are not meeting the needs of children in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. This allegation is UNSUBSTANTIATED.


Exit interview 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: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
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-20240216110102
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 - MANZANITA
FACILITY NUMBER: 010206146
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/21/2024
Section Cited
CCR
101223(a)(2)
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101223 Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
This requirement is not met as evidence by:
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By 03/21/2024 will email a written a plan on how the facility will prevent C1 from injuring another child.
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Based on interviews the licensee did not comply with the section cited above by not ensuring each child is accorded with a safe enviornment, 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: 03/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3