<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013421292
Report Date: 04/13/2023
Date Signed: 04/13/2023 05:27:50 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
03/08/2023 and conducted by Evaluator Indira Loza
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20230308090005
FACILITY NAME:RAYMOND, DOROTHEAFACILITY NUMBER:
013421292
ADMINISTRATOR:RAYMOND, DOROTHEAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 938-6666
CITY:BERKELEYSTATE: CAZIP CODE:
94706
CAPACITY:14CENSUS: 7DATE:
04/13/2023
UNANNOUNCEDTIME BEGAN:
09:44 AM
MET WITH:Sebastian SzlowkowskiTIME COMPLETED:
05:36 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
License - Facility is operating beyond the terms and conditions of the license
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On April 13, 2023 at 9:01am Licensing Program Analyst (LPA) Indira Loza met with Assistants Sebastian Szekalski and Kristen Garcia to continue the investigation for the above allegation. Present during the inspection were the Licensee's two assistants and six preschool age children and one infant. A third assistant, Rajanique Graves-Smith, arrived at around 12:30pm. LPA conducted a tour of the home for a Health and Safety check.

Based on interviews, the Licensee and staff confirmed that the Licensee was out of state for three months, which is more than the 20% allowance in the regulations. The preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED California Code of Regulation (CCR) section 102417(a) is being cited on the attached LIC 9099-D.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023
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 6
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
03/08/2023 and conducted by Evaluator Indira Loza
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20230308090005

FACILITY NAME:RAYMOND, DOROTHEAFACILITY NUMBER:
013421292
ADMINISTRATOR:RAYMOND, DOROTHEAFACILITY TYPE:
810
ADDRESS:1232 NEILSON STTELEPHONE:
(510) 938-6666
CITY:BERKELEYSTATE: CAZIP CODE:
94706
CAPACITY:14CENSUS: 7DATE:
04/13/2023
UNANNOUNCEDTIME BEGAN:
09:44 AM
MET WITH:Sebastian SzlowkowskiTIME COMPLETED:
05:36 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights - Licensee yells at daycare children
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
This is an Amended Report.

On April 13, 2023 at 9:01am Licensing Program Analyst (LPA) Indira Loza met with Assistant Sebastian to continue the investigation for the above allegation. Present during the inspection were the Licensee's three assistants and five preschool age children and one infant.

Based on staff and children interviews conducted during the course of the the investigation which indicated conflicting information about children being yelled at while in care. Therefore, the above allegation is unsubstantiated, although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
03/08/2023 and conducted by Evaluator Indira Loza
COMPLAINT CONTROL NUMBER: 02-CC-20230308090005

FACILITY NAME:RAYMOND, DOROTHEAFACILITY NUMBER:
013421292
ADMINISTRATOR:RAYMOND, DOROTHEAFACILITY TYPE:
810
ADDRESS:1232 NEILSON STTELEPHONE:
(510) 938-6666
CITY:BERKELEYSTATE: CAZIP CODE:
94706
CAPACITY:14CENSUS: 7DATE:
04/13/2023
UNANNOUNCEDTIME BEGAN:
09:44 AM
MET WITH:Sebastian SzlowkowskiTIME COMPLETED:
05:36 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights - Licensee leaves daycare children unattended
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On April 13, 2023 at 9:01am Licensing Program Analyst (LPA) Indira Loza met with Assistants Sebastian Szekalski and Kristen Garcia to continue the investigation for the above allegation. Present during the inspection were the Licensee's two assistants and five preschool age children and one infant. A third assistant, Rajanique Graves-Smith, arrived at around 12:30pm. LPA conducted a tour of the home for a Health and Safety check.

Although one former staff stated the Licensee leaves daycare children unattended, the LPA conducted staff, children, and parent interviews who all stated that the children are not left unattended. Although the allegation may have happened or be valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time.

Exit interview conducted. Report and Appeal Rights provided to Kristen Garcia.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023
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 6
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
03/08/2023 and conducted by Evaluator Indira Loza
COMPLAINT CONTROL NUMBER: 02-CC-20230308090005

FACILITY NAME:RAYMOND, DOROTHEAFACILITY NUMBER:
013421292
ADMINISTRATOR:RAYMOND, DOROTHEAFACILITY TYPE:
810
ADDRESS:1232 NEILSON STTELEPHONE:
(510) 938-6666
CITY:BERKELEYSTATE: CAZIP CODE:
94706
CAPACITY:14CENSUS: 7DATE:
04/13/2023
UNANNOUNCEDTIME BEGAN:
09:44 AM
MET WITH:Sebastian SzlowkowskiTIME COMPLETED:
05:36 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights - Licensee did not provide a safe and comfortable environment for children
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On April 13, 2023 at 9:01am Licensing Program Analyst (LPA) Indira Loza met with Assistants Sebastian Szekalski and Kristen Garcia to continue the investigation for the above allegation. Present during the inspection were the Licensee's two assistants and six preschool age children and one infant. A third assistant, Rajanique Graves-Smith, arrived at around 12:30pm. LPA conducted a tour of the home for a Health and Safety check.

Although the allegation states that the the Licensee did not provide a safe and comfortable environment for children, only one former employee stated that children are in a dangerous environment. Based on child, staff, and parent interviews the environment was observed to be safe and comfortable for the children in care. Although the allegation may have happened or be valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 02-CC-20230308090005
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: RAYMOND, DOROTHEA
FACILITY NUMBER: 013421292
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
CCR
1
2
3
4
5
6
7
1
2
3
4
5
6
7
8
9
10
11
12
13
14
8
9
10
11
12
13
14
Type B
05/01/2023
Section Cited
CCR
102417(a)
1
2
3
4
5
6
7
102417(a) - Operation of a Family Child Care Home: The licensee shall be present in the home and shall ensure that children in care are supervised at all times... Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.
1
2
3
4
5
6
7
Licensee shall review the regulation and watch videos on the "Operation of Family Child Care Homes" on the CDSS website and submit a statement detailing why the regulation exists.
8
9
10
11
12
13
14
This requirement was not met as evidenced by: Based on Licensee, staff, and former staff interviews, the Licensee has been away from the home for more than 20% of the time. This poses a potential Health and Safety risk to the children in care.
8
9
10
11
12
13
14
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: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 6