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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 010206151
Report Date: 10/14/2022
Date Signed: 10/25/2022 05:50:35 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
09/01/2022 and conducted by Evaluator Phyllis Dyer
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20220901115527
FACILITY NAME:OUSD - JEFFERSONFACILITY NUMBER:
010206151
ADMINISTRATOR:GRIFFIN, ANASTASIAFACILITY TYPE:
850
ADDRESS:1975 - 40TH AVENUETELEPHONE:
(510) 436-3700
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY:48CENSUS: 15DATE:
10/14/2022
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Anastasia GriffinTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff did not provide adequate supervision to day care child resulting in day care child leaving facility.
INVESTIGATION FINDINGS:
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LPA Dyer conducted an unannounced complaint inspection to deliver the findings of the above allegation. LPA met with Head Teacher Anastasia Griffin. Present at the facility: head teacher, 2 additional teachers, 3 aids, and 15 preschool children. It was alleged that Staff did not provide adequate supervision to day care child resulting in day care child leaving the facility.
During the course of the investigation, interviews were conducted that revealed a child enrolled at the facility ran through a set of school doors and climbed on a retaining (concrete) wall. There was only a distance of 28 inches between the retaining wall and the top of the chain link fence. The child then climbed over the chain link fence and went down across Mera Street.
The mother arrived to pick up the child and his sibling. She left with one child. It was later determined when the child left the facility he went to a nearby school where a relative was enrolled. This was approximately 1-2 blocks away. The child was brought back by this relative approximately 8 minutes after he left.
(continued)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
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
Control Number 02-CC-20220901115527
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 - JEFFERSON
FACILITY NUMBER: 010206151
VISIT DATE: 10/14/2022
NARRATIVE
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Based on the LPA's observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 12) are being cited on the attached LIC 9099D and must be corrected by the Plan of Correction due date.

The attached type A deficiency is cited today and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parent/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

Exit interview conducted. Licensee was provided copy of their appeal rights. This report must be kept available for public review for 3 years.
Exit interview conducted. Head Teacher was provided copy of appeal rights. Notice of site visit must remain posted for 30 days.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 02-CC-20220901115527
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 - JEFFERSON
FACILITY NUMBER: 010206151
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/17/2022
Section Cited
CCR
101229(a)
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Responsibility for Providing Care and Supervision.(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time.... (1) Supervision shall include visual observation.
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Director and staff will need to provide a document stating how children will not be left without the supervision of a teacher at any time by the POC due date of 10/17/22.
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This requirement was not met as evidenced by report review and interviews: A child wandered away from the facility without staff intervention. Outside the facility he was not under the care or supervision of day care staff. This poses an immediate risk to the Personal Rights of children in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

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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: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3