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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013414163
Report Date: 11/08/2023
Date Signed: 11/08/2023 11:20:27 AM

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
10/06/2023 and conducted by Evaluator Cherie Acosta
COMPLAINT CONTROL NUMBER: 02-CC-20231006123506
FACILITY NAME:FRANKLIN, MAVISFACILITY NUMBER:
013414163
ADMINISTRATOR:FRANKLIN, MAVISFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 638-7008
CITY:OAKLANDSTATE: CAZIP CODE:
94605
CAPACITY:14CENSUS: 3DATE:
11/08/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Mavis FranklinTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Verbal and physical altercations occurred in the presence of day care children
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cherie Acosta and Licensing Program Manager (LPM) Sherelle Johnson conducted an unannounced visit to deliver findings for the above allegation.

On 10/4/23 licensee and a parent of children in care engaged in an argument at the family child care home while children were present.
On 10/5/23 there was a verbal altercation between parents/authorized representative of children in care. On this day the verbal altercation escalated into a physical altercation and S1 was hit by S2. Both the verbal and physical altercations took place in front of children in care.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
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 6
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
10/06/2023 and conducted by Evaluator Cherie Acosta
COMPLAINT CONTROL NUMBER: 02-CC-20231006123506

FACILITY NAME:FRANKLIN, MAVISFACILITY NUMBER:
013414163
ADMINISTRATOR:FRANKLIN, MAVISFACILITY TYPE:
810
ADDRESS:8008 EARL STREETTELEPHONE:
(510) 638-7008
CITY:OAKLANDSTATE: CAZIP CODE:
94605
CAPACITY:14CENSUS: DATE:
11/08/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:TIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Day- care child wandered away from the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cherie Acosta and Licensing Program Manager (LPM) Sherelle Johnson conducted an unannounced visit to deliver findings for the above allegation.

Licensee admitted an incident occurred approximately a year and a half ago. A child in care wandered away from the home through an open gate. The child was found by a passerby and the police were called. The child was returned safely to the family child care home. The parent was notified.

Based interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is to be substantiated.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
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 6
Control Number 02-CC-20231006123506
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: FRANKLIN, MAVIS
FACILITY NUMBER: 013414163
VISIT DATE: 11/08/2023
NARRATIVE
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The attached type A violation is cited today and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC9224). The LIC 9224 must be placed in the child's file to be reviewed by licensing.

Exit interview and report was reviewed with Mavis Franklin.
Notice of Site Visit was provided and must be poster for 30 days.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 02-CC-20231006123506
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: FRANKLIN, MAVIS
FACILITY NUMBER: 013414163
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/09/2023
Section Cited
CCR
102417(a)
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The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and
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Licensee shall develop a written plan of action to ensure there are no future incidents. Licensee shall provided a copy of the plan to CCL by 11/9/23.
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supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day. This requirement was not met as evidenced by: A child wandered away from the home which poses an immediate risk to 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: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 02-CC-20231006123506
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: FRANKLIN, MAVIS
FACILITY NUMBER: 013414163
VISIT DATE: 11/08/2023
NARRATIVE
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Based on interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is to be substantiated.

The attached type A violation is cited today and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC9224). The LIC 9224 must be placed in the child's file to be reviewed by licensing.

Exit interview and report was reviewed with Mavis Franklin.
Notice of Site Visit was provided and must be posted for 30 days.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 02-CC-20231006123506
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: FRANKLIN, MAVIS
FACILITY NUMBER: 013414163
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/09/2023
Section Cited
CCR
102423(a)(2)
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Personal Rights. Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following:
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Licensee shall develop a written plan of action to ensure there are no future incidents. Licensee shall provided a copy of the plan to CCL by 11/9/23.
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To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement was not met as evidenced by: a verbal and physical altercation took place while children were in care which posed an immediate risk to 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: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 6