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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073407423
Report Date: 06/16/2022
Date Signed: 06/16/2022 02:07:20 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
05/27/2022 and conducted by Evaluator Cherie Acosta
COMPLAINT CONTROL NUMBER: 02-CC-20220527101804
FACILITY NAME:BABY YALE ACADEMYFACILITY NUMBER:
073407423
ADMINISTRATOR:LITA REEVESFACILITY TYPE:
850
ADDRESS:5521 LONE TREE WAY STE100TELEPHONE:
(925) 308-7693
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:74CENSUS: 20DATE:
06/16/2022
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Muazzama Afrin Qurashy.TIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff yells at day care children
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Cherie Acosta and Indira Loza conducted an unannounced visit to deliver findings on the above allegation. LPAs met with Director Muazzama Afrin Qurashy.

During the investigation LPAs conducted several interviews. During interviews it was revealed that teachers yell at children in care

Based on interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is to be substantiated.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
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 8
Control Number 02-CC-20220527101804
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: BABY YALE ACADEMY
FACILITY NUMBER: 073407423
VISIT DATE: 06/16/2022
NARRATIVE
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The attached type A violation is cited today and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC9224). The LIC 9224 must be placed in the child's file to be reviewed by licensing.

Exit interview and report reviewed with Lita Reeves Muazzama Afrin Qurashy.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 8
Control Number 02-CC-20220527101804
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: BABY YALE ACADEMY
FACILITY NUMBER: 073407423
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
06/17/2022
Section Cited
CCR
101223(a)(3)
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Personal Rights The licensee shall ensure that each child is accorded the following personal rights: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living
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Director shall submit a written plan of action to CCL by 6/17/22.
Plan of action shall describe how the facility will ensure staff do not yell at children.
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including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning. This requirement was not met as evidenced by: staff yell at children in care which poses an immediate risk to the health and safety of children in care.
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• Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
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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: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 8
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
05/27/2022 and conducted by Evaluator Cherie Acosta
COMPLAINT CONTROL NUMBER: 02-CC-20220527101804

FACILITY NAME:BABY YALE ACADEMYFACILITY NUMBER:
073407423
ADMINISTRATOR:LITA REEVESFACILITY TYPE:
850
ADDRESS:5521 LONE TREE WAY STE100TELEPHONE:
(925) 308-7693
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:74CENSUS: 20DATE:
06/16/2022
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Muazzama Afrin Qurashy.TIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Incident reports are not being given to the authorized representative
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Cherie Acosta and Indira Loza conducted an unannounced visit to deliver findings on the above allegation. LPAs met with Director Muazzama Afrin Qurashy.

During the investigation LPAs conducted several interviews and reviewed documents. Based on the investigation it is determined that on at least one occasion a child in care received an injury and the facility did not provided incident reports to the authorized representative.

Based on interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is to be substantiated.

Exit interview and report reviewed with Muazzama Afrin Qurashy. and Lita Reeves.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 8
Control Number 02-CC-20220527101804
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: BABY YALE ACADEMY
FACILITY NUMBER: 073407423
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
06/30/2022
Section Cited
CCR
101226(a)(2)
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Health-Related Services. The licensee shall immediately notify the child's authorized representative if the child becomes ill or sustains an injury... In the case of less serious injuries including, but not limited to, minor cuts, scratches and bites from other children requiring assessment and/or administration of first aid by staff,
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Director shall submit a written plan of action describing how she will ensure that incident reports are completed when children receive injuries and the authorized representative is informed. Director shall submit this to CCL by 6/30/22
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 the licensee shall document the injury in the child's record and notify the child's authorized representative of the nature of the injury when the child is picked up from the center. This requirement was not met as evidenced by: On at least one occasion an incident was not documented and an incident report was not provided to authorized representative which poses a potential risk to the health and safety of children in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
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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: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 8
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
05/27/2022 and conducted by Evaluator Cherie Acosta
COMPLAINT CONTROL NUMBER: 02-CC-20220527101804

FACILITY NAME:BABY YALE ACADEMYFACILITY NUMBER:
073407423
ADMINISTRATOR:LITA REEVESFACILITY TYPE:
850
ADDRESS:5521 LONE TREE WAY STE100TELEPHONE:
(925) 308-7693
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:74CENSUS: 20DATE:
06/16/2022
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Muazzama Afrin Qurashy.TIME COMPLETED:
02:15 PM
ALLEGATION(S):
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2
3
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9
Day care children received injuries while in care
INVESTIGATION FINDINGS:
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3
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5
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7
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10
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12
13
Licensing Program Analysts (LPA) Cherie Acosta and Indira Loza conducted an unannounced visit to deliver findings on the above allegation. LPAs met with Director Muazzama Afrin Qurashy.

During the investigation LPAs conducted several interviews. Based on the investigation it is determined that multiple children in care have received injuries and staff did not know how the injury occurred.

Based on interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is to be substantiated.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 8
Control Number 02-CC-20220527101804
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: BABY YALE ACADEMY
FACILITY NUMBER: 073407423
VISIT DATE: 06/16/2022
NARRATIVE
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The attached type A violation is cited today and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC9224). The LIC 9224 must be placed in the child's file to be reviewed by licensing.

Exit interview and report reviewed with Muazzama Afrin Qurashy. and Lita Reeves.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
LIC9099 (FAS) - (06/04)
Page: 7 of 8
Control Number 02-CC-20220527101804
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: BABY YALE ACADEMY
FACILITY NUMBER: 073407423
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
06/17/2022
Section Cited
CCR
101229(a)
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Responsibility for Providing Care and Supervision. The licensee shall provide care and supervision as necessary to meet the children's needs. This requirement was not met as evidenced by
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Director shall submit a written plan of action by 6/17/22. Plan of action shall describe actions taken to prevent future incidents
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children in care have received injuries and staff did not know how the injury occurred which poses an immediate risk to the health and safety of children in care.
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 Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
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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: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
LIC9099 (FAS) - (06/04)
Page: 8 of 8