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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073408207
Report Date: 10/26/2022
Date Signed: 10/26/2022 05:22:00 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
09/15/2022 and conducted by Evaluator Cherie Acosta
COMPLAINT CONTROL NUMBER: 02-CC-20220915152752
FACILITY NAME:BABY YALE ACADEMYFACILITY NUMBER:
073408207
ADMINISTRATOR:MUAZZAMA(AFRIN) QURASHYFACILITY TYPE:
840
ADDRESS:5521 LONE TREE WAY STE. 100TELEPHONE:
(925) 308-7693
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:15CENSUS: 10DATE:
10/26/2022
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Muazzama (Afrin) Qurashy.TIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Staff inappropriately handled child in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cherie Acosta and Indira Loza conducted an unannounced visit to investigate the above allegation. LPAs met with Director Muazzama (Afrin) Qurashy and Licensee Lita Reeves

During the investigation LPAs conducted multiple interviews. Based on interviews conducted it is determined that S1 inappropriately handled children in care. Based on interviews conducted S1 has pulled and squeezed children's arms.

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: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
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 3
Control Number 02-CC-20220915152752
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: 073408207
VISIT DATE: 10/26/2022
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
Notice of Site Visit was provided and must be posted for 30 days.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 02-CC-20220915152752
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: 073408207
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
10/27/2022
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 including
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Director shall provide personal rights training to staff. Director shall submit training agenda to CCL by 10/27/22. Director shall provide proof of completed training. All staff shall write a statement about what they learned in the training and submit to CCL by 11/14/22
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eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning. This requirement was not met as evidenced by:S1 inappropriately handled children in care, which posses an immediate health and safety risk to 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: 10/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3