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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013420965
Report Date: 10/08/2025
Date Signed: 10/08/2025 03:26:02 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
09/05/2025 and conducted by Evaluator Kayla Merchant
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20250905111050
FACILITY NAME:BERKELEY YMCA HEAD START - SOUTH YMCAFACILITY NUMBER:
013420965
ADMINISTRATOR:DORIAN BURNLEYFACILITY TYPE:
830
ADDRESS:2901 CALIFORNIA STTELEPHONE:
(510) 649-7988
CITY:BERKELEYSTATE: CAZIP CODE:
94703
CAPACITY:42CENSUS: 28DATE:
10/08/2025
UNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Nicole GibbsTIME COMPLETED:
03:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Day care child sustained an unexplained injury
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/8/2025 at 2:05 PM, Licensing Program Analyst (LPA) Kayla Merchant conducted an unannounced Subsequent Complaint Investigation at Berkeley YMCA Head Start – South YMCA. LPA met with Director, Nicole Gibbs to present the findings of the investigation.
During the course of investigation, LPA conducted facility inspection, record review, interviews and obtained documents. Complainant alleges that on 8/11/2025, C1 sustained an injury to her forehead while in care. Police and Fire Department Paramedics were called at the time of the incident. Police records indicate, while outside the facility, medical personnel completed a full assessment of C1 and determined that C1 did not have any injuries on their body, other than what the investigating officer called a bruise on C1’s forehead. The investigating officer did not find any evidence that abuse, or neglect occurred at the facility that may have caused the bruise. Although C1 appeared to have a bruise on her forehead, LPA could not determine where and how C1 received the bruise.
Therefore the allegation is UNSUBSTANTIATED which means 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. No Deficiency has been cited for this allegation.
Exit interview conducted with Director Nicole Gibbs.
A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 DAYS.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Kayla Merchant
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025
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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