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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013421292
Report Date: 10/23/2023
Date Signed: 10/23/2023 02:33:12 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
08/01/2023 and conducted by Evaluator Indira Loza
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20230801153451
FACILITY NAME:RAYMOND, DOROTHEAFACILITY NUMBER:
013421292
ADMINISTRATOR:RAYMOND, DOROTHEAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 938-6666
CITY:BERKELEYSTATE: CAZIP CODE:
94706
CAPACITY:14CENSUS: 0DATE:
10/23/2023
UNANNOUNCEDTIME BEGAN:
12:56 PM
MET WITH:Dorothea RaymondTIME COMPLETED:
02:43 PM
ALLEGATION(S):
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9
Personal Rights - Daycare child sustained diaper rashes while in care
INVESTIGATION FINDINGS:
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13
On October 23, 2023 at 12:56pm Licensing Program Analyst (LPA) Indira Loza spoke with Licensee Dorothea Raymond to deliver the complaint findings. There were no children in care during today's visit. Throughout the course of the investigation, parent and staff interviews were conducted.

Throughout the course of the investigation, parent and staff interviews were conducted and indicated that their child has not gotten any diaper rashes while in care. Therefore this allegation has been Unsubstantiated. Although the allegation is valid and may have happened, the preponderance of evidence standard has not been met.

Exit interview conducted with Licensee Dorothea Raymond.
Report, Notice of Site Visit, and Appeal Rights provided to the Licensee.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023
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
08/01/2023 and conducted by Evaluator Indira Loza
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20230801153451

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: 0DATE:
10/23/2023
UNANNOUNCEDTIME BEGAN:
12:56 PM
MET WITH:Dorothea RaymondTIME COMPLETED:
02:43 PM
ALLEGATION(S):
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2
3
4
5
6
7
8
9
Personal Rights - Staff left daycare child unattended in soiled diaper for extended periods of time
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On October 23, 2023 at 12:56pm Licensing Program Analyst (LPA) Indira Loza spoke with Licensee Dorothea Raymond to deliver the complaint findings. There were no children in care during today's visit. Throughout the course of the investigation, parent and staff interviews were conducted.

Parent interviews indicated that their child was left in a soiled diaper for an extended period of time. Based on the interviews conducted throughout the investigation, the preponderance of evidence standard has been met. Therefore, the allegation is SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 is being cited on 9099-D page.

Report reviewed with Licensee Dorothea Raymond. Report and Appeal Rights provided. Notice of Site Visit must remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 02-CC-20230801153451
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: 10/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/19/2023
Section Cited
CCR
102423(a)(1)
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(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged...These rights include, but are not limited to, the following:(1) To be treated with dignity in his/her personal relationship with staff and other persons.
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The Licensee is to develop and send the LPA a plan that ensures all diapers are changed frequently, no later than 10/23/23.
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This requirement was not met as evidenced by: Based on parent interviews it has been determined that on at least two ocassions a child's diaper had not been changed, which poses an immediate Health, Safety, and Personal Rights risk to children in care.
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14
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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: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023
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
08/01/2023 and conducted by Evaluator Indira Loza
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20230801153451

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: 0DATE:
10/23/2023
UNANNOUNCEDTIME BEGAN:
12:56 PM
MET WITH:Dorothea RaymondTIME COMPLETED:
02:43 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
License - Licensee operates beyond the terms and conditions of the license
INVESTIGATION FINDINGS:
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2
3
4
5
6
7
8
9
10
11
12
13
On October 23, 2023 at 12:56pm Licensing Program Analyst (LPA) Indira Loza spoke with Licensee Dorothea Raymond to deliver the complaint findings. There were no children in care during today's visit. Throughout the course of the investigation, parent and staff interviews were conducted.

Parent and staff interviews indicated that the Licensee was not home for at 34% of the time exceeding the 20% allowance. Based on the interviews conducted throughout the investigation, the preponderance of evidence standard has been met. Therefore, the allegation is SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 is being cited on 9099-D page.

Report reviewed with Licensee Dorothea Raymond. Report and Appeal Rights provided. Notice of Site Visit must remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023
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
Control Number 02-CC-20230801153451
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: 10/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/20/2023
Section Cited
CCR
102417(a)
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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.
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Licensee shall review the regulation and watch videos on the "Operation of Family Child Care Homes" on the CDSS website and submit a statement explaining what they have learned, no later than November 20, 2023.
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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.
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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: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 6