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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013418757
Report Date: 11/21/2022
Date Signed: 11/21/2022 12:08:33 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 STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/28/2022 and conducted by Evaluator Lorraine Dacanay-Breaux
COMPLAINT CONTROL NUMBER: 52-CC-20220928171516
FACILITY NAME:FERNANDEZ, TERESAFACILITY NUMBER:
013418757
ADMINISTRATOR:FERNANDEZ, TERESAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 457-3477
CITY:PLEASANTONSTATE: CAZIP CODE:
94588
CAPACITY:14CENSUS: 5DATE:
11/21/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Teresa FernandezTIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On November 21, 2022, Licensing Program Analyst (LPA) Lorraine Dacanay Breaux conducted an unannounced visit for the purpose of investigating a complaint for the above allegation and met with Licensee, Teresa Fernandez. At the time of the visit there are five (5) children in care.

Based on interviews conducted, the complaint is UNSUBSTANTIATED, meaning it cannot be proven or disproven that the "licensee yelling in the presence of day-care children". 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 UNSUBSTANTIATED.

The licensee was provided a copy of this report and appeal rights, and the signature on this form acknowledges receipt of these rights, An exit interview was conducted with the licensee, Teresa Fernanadez and a Notice of Site was provided and must be posted for 30 days.



Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022
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
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 STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/28/2022 and conducted by Evaluator Lorraine Dacanay-Breaux
COMPLAINT CONTROL NUMBER: 52-CC-20220928171516

FACILITY NAME:FERNANDEZ, TERESAFACILITY NUMBER:
013418757
ADMINISTRATOR:FERNANDEZ, TERESAFACILITY TYPE:
810
ADDRESS:4079 SUFFOLK WAYTELEPHONE:
(925) 457-3477
CITY:PLEASANTONSTATE: CAZIP CODE:
94588
CAPACITY:14CENSUS: 5DATE:
11/21/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Teresa FernandezTIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On November 21, 2022, Licensing Program Analyst (LPA) Lorraine Dacanay Breaux conducted an unannounced complaint investigation at the facility and met with the licensee, Teresa Fernandez and explained the purpose of today's inspection. There were five (5) children in care. LPA Dacanay Breaux delivered the finding for the above allegation during the visit.

Based on interviews conducted, the complaint is UNSUBSTANTIATED, meaning it cannot be proven or disproven that the "Staff not providing a safe environment for children in care". 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 UNSUBSTANTIATED.

The licensee was provided a copy of this report and appeals, and the signature on this form acknowledges receipt of these rights, An exit interview was conducted with the licensee, Teresa Fernanadez and a Notice of Site was provided and must be posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022
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 2