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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013417305
Report Date: 10/12/2023
Date Signed: 10/12/2023 12:07:35 PM

Unsubstantiated


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
08/22/2023 and conducted by Evaluator Diana Campos
COMPLAINT CONTROL NUMBER: 02-CC-20230822091007
FACILITY NAME:S.S.U.C. - DE COLORES HEADSTART & EARLY HEADSTARTFACILITY NUMBER:
013417305
ADMINISTRATOR:MICHELLE FREEMANFACILITY TYPE:
850
ADDRESS:1155 - 35TH AVENUETELEPHONE:
(510) 535-6106
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY:134CENSUS: 69DATE:
10/12/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Ana BautistaTIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
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9
Day care child sustained an unexplained injury while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
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9
10
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13
LPA Diana Campos met with center Director Ana Bautista for a complaint investigation regarding the above allegation. It was alleged that a child sustained an injury that resembled a hand print on his face without staff's knowledge and/or observation. During the course of the investigation, interviews were conducted. After picking up her child at the end of the day, a parent informed Director that a hand print was observed on a child who could not verbalize what occurred. Per staff, the child did not suffer any injury nor display any marks or signs of discomfort or infliction of pain during the day. Interviews revealed that child was observed sleeping face down on his hands for the duration of his nap. Per staff child did not display any visible marks upon pickup. Neither staff, nor the parent were able to determine how, when and/or where the alleged injury may have occurred. Based on the investigative findings LPA was unable to determine if the alleged hand print on child's face happened as a result of a personal rights violation or due to child sleeping on his own hands during nap time.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged personal rights violation(s) did or did not occur. Therefore, the allegation is unsubstantiated.

Exit interview conducted and report reviewed with Center Director Ana Bautista.
Notice of Site Visit provided and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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