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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013415253
Report Date: 10/02/2024
Date Signed: 10/02/2024 04:15:40 PM

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
09/23/2024 and conducted by Evaluator Michael Mathew
COMPLAINT CONTROL NUMBER: 52-CC-20240923164805
FACILITY NAME:DAVIS STREET COMMUNITY CENTERFACILITY NUMBER:
013415253
ADMINISTRATOR:MURILLO, TRISHFACILITY TYPE:
840
ADDRESS:951 DOWLING BOULEVARDTELEPHONE:
(510) 777-9317
CITY:SAN LEANDROSTATE: CAZIP CODE:
94577
CAPACITY:60CENSUS: DATE:
10/02/2024
UNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Maggie AndersonTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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operating out of ratio
INVESTIGATION FINDINGS:
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On October 2, 2024 at, 1:35 PM Licensing Program Analyst (LPA) Michael Mathew conducted an unannounced inspection to conclude a complaint investigation LPA met with director Maggie Anderson and advised her the purpose of the inspection. Director provided LPA a tour of the facility inside and out. There were 11 children and 2 staff in care at the time of the inspection.

Based on LPA interviews which were conducted, and At 2:01 PM on 10/2/24, LPA observed 15 children to 1 staff in room 2 and 18 children to 1 staff in Room 1. The preponderance of evidence standard has been met, therefore the above allegation of operating out of ratio is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12, Chapter 1, Article 06, Section: 101516.5(b)(1) Teacher-Child Ratio, are being cited on the attached LIC 9099D.

A notice of site visit and appeal rights were given. Exit interview conducted and report was reviewed with Director Maggie Anderson
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Michael Mathew
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
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 2
Control Number 52-CC-20240923164805
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: DAVIS STREET COMMUNITY CENTER
FACILITY NUMBER: 013415253
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/16/2024
Section Cited
CCR
101516.5(b)(1)
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101516.5(b)(1) Teacher-Child Ratio: .A teacher shall supervise no more than 14 children or with an aide a maximum of 28 children.

This requirement is not met as evidenced by:
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Director agreed to sent LPA a letter on how the facility will keep ratio by end of day 10/16/24.
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Based on interviews with staff,and At 2:01 PM on 10/2/24, LPA observed 15 children to 1 staff in room 2 and 18 children to 1 staff in Room 1. The facility did not comply with the section cited above as the facility operated out of ratio 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: Michael Mathew
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2