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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013420964
Report Date: 11/16/2023
Date Signed: 01/26/2024 09:18:52 AM

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
09/12/2023 and conducted by Evaluator Diana Campos
COMPLAINT CONTROL NUMBER: 02-CC-20230912134530
FACILITY NAME:BERKELEY YMCA HEAD START - EMERYVILLE MARINAFACILITY NUMBER:
013420964
ADMINISTRATOR:WILLIAMS, ROCHELLE LA'RUEFACILITY TYPE:
830
ADDRESS:1275 - 61ST STTELEPHONE:
(510) 601-8674
CITY:EMERYVILLESTATE: CAZIP CODE:
94608
CAPACITY:40CENSUS: 20DATE:
11/16/2023
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Dereka GoudeauTIME COMPLETED:
01:05 PM
ALLEGATION(S):
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7
8
9
Staff handling infant in a rough manner
INVESTIGATION FINDINGS:
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13
****This is an amended version of the original report dated 11/16/2023****
LPA Diana Campos met with Head Teacher Dereka Goudeau for a complaint investigation regarding the above allegation. Present for the investigation were 13 staff and 20 children in care. During the investigation, interviews were conducted. It was alleged that staff handled a child in a rough manner. Based on conflicting statements made to the analyst during interviews, LPA could not determine whether or not a child was handled in a rough manner. Therefore, the above allegation is unsubstantiated.
Exit interview conducted and report reviewed with Head Teacher Dereka Goudeau.

A Notice of Site Visit was 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: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
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-20230912134530
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: BERKELEY YMCA HEAD START - EMERYVILLE MARINA
FACILITY NUMBER: 013420964
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
CCR
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1
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7
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7
1
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7
1
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7
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: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 02-CC-20230912134530
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: BERKELEY YMCA HEAD START - EMERYVILLE MARINA
FACILITY NUMBER: 013420964
VISIT DATE: 11/16/2023
NARRATIVE
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LPA informed Head Teacher Dereka Goudeau that this report dated 11/16/2023 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA informed the licensee to provide a copy of this licensing report dated that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3