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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 010214801
Report Date: 09/19/2024
Date Signed: 09/19/2024 10:49:44 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/19/2024 and conducted by Evaluator Jyoti Saini
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20240819110216
FACILITY NAME:EXTENDED DAY CHILD CARE - FREDERIKSENFACILITY NUMBER:
010214801
ADMINISTRATOR:OCHOA, ROSAMARIAFACILITY TYPE:
840
ADDRESS:7243 TAMARACK DRIVETELEPHONE:
(925) 833-0127
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY:180CENSUS: 0DATE:
09/19/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Director, Rosamaria Ochoa and Executive Director, Vanessa castilloTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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-Children were unsupervised in the bathroom.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jyoti Saini arrived unannounced to deliver the findings from a complaint investigation for the above allegation. LPA met with head teacher Cyndee Ullom. The facility director, RosaMaria Ochoa and Executive Director Vanessa Castillo arrived during the inspection. LPA explained the purpose of the inspection. There were no children present during the inspection today. Based on the interview, observations, and record reviews, the facility has acknowledged that an incident occurred in which two children were found in a single stall, which concludes that the children were left unsupervised in the bathroom. The preponderance of evidence standard has been met; therefore, the allegation is found to be SUBSTANTIATED. California Code of Regulations, {Title 22, Division 12, Chapter 1, Section 101229 (1) is being cited on the attached LIC 9099D.
see next page...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
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 7
Control Number 52-CC-20240819110216
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: EXTENDED DAY CHILD CARE - FREDERIKSEN
FACILITY NUMBER: 010214801
VISIT DATE: 09/19/2024
NARRATIVE
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THE LICENSEE MUST POST ANY TYPE A DEFICIENCIES DURING TODAY'S VISIT WITH THE NOTICE, AND THE LICENSEE UNDERSTANDS THE NOTICE AND TYPE A DEFICIENCIES MUST REMAIN POSTED FOR THIRTY DAYS. REQUIREMENTS FOR THE AB 633 FACT SHEET AND A COPY OF THE ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC 9224) WERE DISCUSSED WITH PROVIDER. PROVIDER UNDERSTANDS THIS REQUIREMENT.

A notice of site visit was given and must remain posted for a period of 30 days.



An exit interview was conducted, and appeal rights were reviewed and given to the facility representatives, Rosamaria Ochoa and Vanessa Castillo.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 52-CC-20240819110216
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: EXTENDED DAY CHILD CARE - FREDERIKSEN
FACILITY NUMBER: 010214801
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/20/2024
Section Cited
CCR
101229(1)
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101229(1) Responsibility for Providing Care and Supervision
(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
This requirement is not met as evidenced by:
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The facility must submit a written plan to the Community Care licensing division (CCLD) outlining the steps to be taken to enhance supervision and prevent similar incidents in the future. All agenda items and signatures of attendees should be emailed to the Licensing Program Analyst (LPA) by the POC due date.

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Based on observations,interviews, and record reviews, the Licensee did not comply with the section cited above. Two children were found in the same stall, which poses an immediate risk to the health, safety, and personal rights of the 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: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/19/2024 and conducted by Evaluator Jyoti Saini
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20240819110216

FACILITY NAME:EXTENDED DAY CHILD CARE - FREDERIKSENFACILITY NUMBER:
010214801
ADMINISTRATOR:OCHOA, ROSAMARIAFACILITY TYPE:
840
ADDRESS:7243 TAMARACK DRIVETELEPHONE:
(925) 833-0127
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY:180CENSUS: 0DATE:
09/19/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Director, Rosamaria Ochoa and Executive Director, Vanessa castilloTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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-Inappropriate acts between children in the bathroom.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jyoti Saini arrived unannounced to deliver the findings from a complaint investigation for the above allegation. LPA met with head teacher Cyndee Ullom. The facility director, RosaMaria Ochoa and Executive Director Vanessa Castillo arrived during the inspection. LPA explained the purpose of the inspection. There were no children present during the inspection today.
Based on the interview, observations, and record reviews, the facility acknowledge that an incident occurred where two children were found in a single stall; however, no one witnessed any inappropriate interactions. Therefore, the alleged Inappropriate acts between children in the bathroom may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is "Unsubstantiated".
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 52-CC-20240819110216
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: EXTENDED DAY CHILD CARE - FREDERIKSEN
FACILITY NUMBER: 010214801
VISIT DATE: 09/19/2024
NARRATIVE
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A notice of site visit was given and must remain posted for a period of 30 days.

An exit interview was conducted, and appeal rights were reviewed and given to the facility representatives, Rosamaria Ochoa and Vanessa Castillo.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/19/2024 and conducted by Evaluator Jyoti Saini
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20240819110216

FACILITY NAME:EXTENDED DAY CHILD CARE - FREDERIKSENFACILITY NUMBER:
010214801
ADMINISTRATOR:OCHOA, ROSAMARIAFACILITY TYPE:
840
ADDRESS:7243 TAMARACK DRIVETELEPHONE:
(925) 833-0127
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY:180CENSUS: 0DATE:
09/19/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Director Rosamaria Ochoa and Executive Director, Vanessa castilloTIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
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7
8
9
-Failure to report incident to licensing.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jyoti Saini arrived unannounced to deliver the findings from a complaint investigation for the above allegation. LPA met with head teacher Cyndee Ullom. The facility director, RosaMaria Ochoa and Executive Director Vanessa Castillo arrived during the inspection. LPA explained the purpose of the inspection. There were no children present during the inspection today.
Based on the interview, observations, and record reviews, LPA determined that an unusual incident, occurred in August 2024. However, the facility failed to report it to the community care licensing division (CCLD). The preponderance of evidence standard has been met; therefore, the allegation is found to be SUBSTANTIATED. California Code of Regulations, {Title 22, Division 12, Chapter 1, Section 101212 (d) is being cited on the attached LIC 9099D.

A notice of site visit was given and must remain posted for a period of 30 days.

An exit interview was conducted, and appeal rights were reviewed and given to the facility representatives, Rosamaria Ochoa and Vanessa Castillo.




Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 52-CC-20240819110216
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: EXTENDED DAY CHILD CARE - FREDERIKSEN
FACILITY NUMBER: 010214801
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/27/2024
Section Cited
CCR
101212(d)
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101212 (d) Reporting Requirements: Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, 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 (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.
This requirement is not met as evidence by:
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The Facility shall watch the "Child Care Reporting Requirements" at www.ccld.childcarevideos.org and submit a written statement explaining when and how an event should be reported to the Community Care Licensing Division(CCLD) by the POC date.
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Based on the record review, the licensees did not comply with the section cited above. The facility failed to report the incident to the Community Care Licensing Division (CCLD) that occurred in August 2024, which poses a potential health, safety, or personal rights risk to persons 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: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
LIC9099 (FAS) - (06/04)
Page: 7 of 7