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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013419051
Report Date: 02/18/2022
Date Signed: 02/18/2022 02:37:35 PM

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
11/22/2021 and conducted by Evaluator Catherine Fernandes
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20211122093904
FACILITY NAME:NEWMAN, CHISHIROFACILITY NUMBER:
013419051
ADMINISTRATOR:NEWMAN, CHISHIROFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 336-0299
CITY:OAKLANDSTATE: CAZIP CODE:
94619
CAPACITY:14CENSUS: 10DATE:
02/18/2022
UNANNOUNCEDTIME BEGAN:
12:19 PM
MET WITH:Chishiro Newman TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Provider utilizes off limits space for day care children.
INVESTIGATION FINDINGS:
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On 2/18/22 at 12:19PM, Licensing Program Analyst (LPA) Catherine Fernandes arrived unannounced to deliver the findings for the above allegation, LPA was greeted by Licensee Chishiro Newman. During the course of the investigation LPA Fernandes conducted interviews and observed the home. Present for this inspection was four infants, six toddlers and two staff members.

Based on observations LPA Fernandes arrived to the home on 2/18/22 and 11/29/21 and observed the off limit bedroom being used as a nap area. Licensee also confirmed that she has been using the bedroom for a few months and was unaware it was off limits. Therefore the allegation is SUBSTANTIATED, the preponderance of evidence standard has been met. Title 22, is being cited on the attached LIC. 9099D.

Appeal Rights were discussed
An exit interview was conducted with Licensee
Report, Appeal Rights and Notice of site visit was provided
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022
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 3
Control Number 02-CC-20211122093904
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: NEWMAN, CHISHIRO
FACILITY NUMBER: 013419051
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/01/2022
Section Cited
CCR
102416.3(a)(6)
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Alterations to Existing Buildings or Grounds- Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care. This requirement has not been met as evidenced by:

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Licensee is to have the room inspected so it may be used as an on limit area and review the regulations regarding Alterations then sign a written statement of understanding by proof of correction date.

*while at the home LPA Fernandes inspected the room and made it on limit.
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Based on LPA's observations and conformation the Licensee the off limit bedroom on the left side of the hallway was being used as a nap room, which can be a potential risk to children 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: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3