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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013422004
Report Date: 10/30/2023
Date Signed: 10/30/2023 02:24:03 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, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/23/2023 and conducted by Evaluator Ashley Curry
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20231023092109
FACILITY NAME:OUSD - ARROYO VIEJO CDCFACILITY NUMBER:
013422004
ADMINISTRATOR:JOY FORTE`FACILITY TYPE:
850
ADDRESS:1895 - 78TH AVETELEPHONE:
(510) 636-1254
CITY:OAKLANDSTATE: CAZIP CODE:
94621
CAPACITY:72CENSUS: 32DATE:
10/30/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Lynn Pfeiffer/ Caroline Jones TIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
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9
Child received unexplained brusing while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
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9
10
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13
On 10/30/2023 at 9:15 AM Licensing Program Analyst (LPA), A. Curry conducted an unannounced complaint inspection for the above allegation. LPA met with the Lead Teacher, Lynn Pfeiffer, to explain the pupose of today's visit. The LPA toured the facility, made observations, retrieved documentation, and conducted interviews with staff and children. Based on the information gathered through interviews, it could not be determined that a child sustained bruising while in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. This allegation is Unsubstantiated.

Exit interview conducted, appeal rights were given, and report was reviewed with Lead Teacher, Lynn Pfeiffer and Site Principal, Caroline Jones (via telephone).
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023
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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