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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 070203871
Report Date: 09/18/2024
Date Signed: 09/18/2024 04:27:47 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
09/16/2024 and conducted by Evaluator Cherie Acosta
COMPLAINT CONTROL NUMBER: 02-CC-20240916112235
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: 66DATE:
09/18/2024
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Colleen WilsonTIME COMPLETED:
04:40 PM
ALLEGATION(S):
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Staff hit child in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cherie Acosta and Kareeca Sykes conducted an unannounced visit to investigate the above allegation. LPAs met with Director Colleen Wilson.

During the investigation LPAs conducted interviews and obtained copies of documents. It was reported that a teacher threw a shoe at a child in care. The shoes hit the child in the head.

Based on interviews which were conducted and record reviews, 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: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024
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-20240916112235
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
VISIT DATE: 09/18/2024
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 Colleen Wilson.

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: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 02-CC-20240916112235
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: 09/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/19/2024
Section Cited
CCR
101223.2(a)
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Discipline. Any form of discipline or punishment that violates a child's personal rights as specified in Section 101223 shall not be permitted regardless of authorized representative consent or authorization.
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Director shall develop a written plan of action to ensure there are no future incidents. A copy of this plan shall be submitted to CCL by 9/19/24. Director shall also notify child's parent of the incident and submit proof that the parent has been notified by 9/19/24.
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This requirement was not met as evidenced by; staff threw a shoe at a child in care. The shoes hit the child in the head which is an immediate risk to the health, safety and personal rights 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: 09/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3