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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013422758
Report Date: 02/15/2024
Date Signed: 02/15/2024 12:40:43 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 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
10/10/2023 and conducted by Evaluator April Wright
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20231010094257
FACILITY NAME:TRIPATHI, ANJUFACILITY NUMBER:
013422758
ADMINISTRATOR:TRIPATHI, ANJUFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 666-6320
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY:14CENSUS: 4DATE:
02/15/2024
ANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Anju TripathiTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Neglect/Lack of Supervision - Provider did not provide adequate supervision resulting in child sustaining multiple bites
Personal Rights
INVESTIGATION FINDINGS:
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On October 16th, 2023, at approximately 10:05am, Licensing Program Analyst (LPA) April Wright conducted an unannounced complaint investigation inspection and met with Licensee Anju Tripathi. LPA informed licensee of one (1) allegation against the facility license. Allegation being Personal Rights. No interviews were conducted at this time. Complaint was assigned to CCLD Investigations Bureau (IB) for further investigation and was completed on 12/5/2023.

Based on IB Investigators observations, interviews which were conducted and reports/documentation that was received and reviewed, the preponderance of evidence standard has been met, therefore the above allegation that Provider did not provide adequate supervision resulting in child sustaining multiple bites is found to be SUBSTANTIATED. California Code of Regulations 102423(2), Title 22, Division 12 & Chapter 1 article 6, are being cited on the attached LIC 9099D. A civil penalty of $500 has being assessed.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024
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
Control Number 52-CC-20231010094257
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: TRIPATHI, ANJU
FACILITY NUMBER: 013422758
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/16/2024
Section Cited
CCR
102423(2)
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Personal Rights: (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement is not met as evidenced by: Based on interviews, documentation received and
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View the Child Care Videos for Providers: (1.) Supervising Children in family childcare and (2.) Children’s Personal Rights in childcare.
Write a page stating what the videos were and your understanding of these videos as pertaining to License Daycare Providers.
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record review, the licensee did not comply with the section cited above in which a child sustained injures while in care which poses an immediate health, safety or personal rights risk to children in care. A civil penalty of $500 is being assessed.
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Submit your signed written document to your Licensing Program Analyst within three business days from the date of this meeting. Upon receipt of your document your deficiency will be cleared.
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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: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024
LIC9099 (FAS) - (06/04)
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