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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 070203871
Report Date: 06/09/2021
Date Signed: 06/09/2021 11:23:04 AM

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
06/02/2021 and conducted by Evaluator Caroline Colson
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20210602165605
FACILITY NAME:ST. MICHAELS EPISCOPAL DAY PRESCHOOLFACILITY NUMBER:
070203871
ADMINISTRATOR:WILSON, COLLEENFACILITY TYPE:
850
ADDRESS:2925 BONIFACIO STREETTELEPHONE:
(925) 685-8862
CITY:CONCORDSTATE: CAZIP CODE:
94519
CAPACITY:90CENSUS: 74DATE:
06/09/2021
UNANNOUNCEDTIME BEGAN:
09:53 AM
MET WITH:Colleen WilsonTIME COMPLETED:
11:37 AM
ALLEGATION(S):
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Personal Rights - Facility is not taking necessary precautions to prevent the spread of COVID-19
INVESTIGATION FINDINGS:
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Licensing Program Analyst Caroline Colson met with Colleen Wilson for an unannounced complaint investigation regarding the above allegation at 9:53 AM. The allegation is that staff and children aren't wearing masks in or outside of the facility. LPA witnessed during the facility tour that all the children aren't wearing masks. Based on LPA's interviews which were conducted and a record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, 101223(a)(2) is being cited on the attached LIC 9099 D.

The attached type B deficiency is being cited today and must be corrected by the due date. An exit interview was conducted. Appeal rights were given and discussed. This report must be available for public review for 3 years.

Please See LIC 9099 D for deficiency
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2021
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 02-CC-20210602165605
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: ST. MICHAELS EPISCOPAL DAY PRESCHOOL
FACILITY NUMBER: 070203871
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/09/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/16/2021
Section Cited
CCR
101223(a)(2)
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Personal Rights
To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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By POC Due Date: Licensee will submit a copy of the letter that will be sent to all parents regarding requirement to wear a facial covering. Furthermore, all staff will place masks on all children who are 2 years of age and older at the facility.
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The facility didn't required all children over the age of 2 years old to wear a mask. The requirement was not met as evidenced by document review and licensee interview. This poses a potential health and safety risk to children in care.
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By POC Due Date: Licensee will submit a copy of the letter to parents by June 9, 2021. The deficiency was corrected today.
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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: Caroline Colson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2021
LIC9099 (FAS) - (06/04)
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