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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013417824
Report Date: 05/31/2024
Date Signed: 05/31/2024 12:20:21 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 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
04/10/2024 and conducted by Evaluator Janai McClain
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20240410130206
FACILITY NAME:NIKASIA CHILD CARE CENTERFACILITY NUMBER:
013417824
ADMINISTRATOR:LEWIS, GWENDOLYNFACILITY TYPE:
850
ADDRESS:4143 MACARTHUR BLVD.TELEPHONE:
(510) 531-9130
CITY:OAKLANDSTATE: CAZIP CODE:
94619
CAPACITY:12CENSUS: 8DATE:
05/31/2024
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Nikita LewisTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
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5
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7
8
9
Lack of supervision- Child was left alone in a dark room without supervision
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 5/31/2024 Licensing Program Analyst (LPA) Janai McClain conducted an unannounced visit to deliver findings for the above allegation. LPA met with assistant Nikita Lewis.

During the investigation, LPA conducted facility inspection, observations, record review, interviews and obtained documents. It could not be determined that a child was left alone as a result of lack of supervision. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated.

Exit interview conducted and report reviewed with Nikita Lewis. Notice of Site visit was provided and must be posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Janai McClain
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024
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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