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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 070211160
Report Date: 11/09/2022
Date Signed: 11/09/2022 04:20:24 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
09/16/2022 and conducted by Evaluator Michelle Sutton
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20220916153737
FACILITY NAME:FIRST LUTHERAN CHRISTIAN PRESCHOOLFACILITY NUMBER:
070211160
ADMINISTRATOR:BARRY, MARIANNAFACILITY TYPE:
850
ADDRESS:4006 CONCORD BOULEVARDTELEPHONE:
(925) 798-5330
CITY:CONCORDSTATE: CAZIP CODE:
94519
CAPACITY:60CENSUS: 32DATE:
11/09/2022
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Jeni SmithTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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9
Day care children inappropriately touched another day care child while in care.
INVESTIGATION FINDINGS:
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On 11/9/22 at 3:30 PM Licensing Program Analyst (LPA) Michelle Sutton conducted a Complaint Investigation at First Lutheran Christian Preschool and met with Director Jeni Smith to present the findings of the investigation. During the course of the investigation, LPA inspected the facility, reviewed records, and conducted interviews. The allegation is day care children inappropriately touched another day care child while in care. It was determined a day care child was inappropriately touched by another day care child during free play. There was not a preponderance of evidence to substantiate lack of supervision, however the child’s personal rights was violated. Therefore, the allegation is SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 is being cited on 9099-D page.

The following deficiency were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the director Jeni Smith.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle SuttonTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
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
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
09/16/2022 and conducted by Evaluator Michelle Sutton
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20220916153737

FACILITY NAME:FIRST LUTHERAN CHRISTIAN PRESCHOOLFACILITY NUMBER:
070211160
ADMINISTRATOR:BARRY, MARIANNAFACILITY TYPE:
850
ADDRESS:4006 CONCORD BOULEVARDTELEPHONE:
(925) 798-5330
CITY:CONCORDSTATE: CAZIP CODE:
94519
CAPACITY:60CENSUS: DATE:
11/09/2022
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Jeni SmithTIME COMPLETED:
04:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not communicate with authorized representative.
INVESTIGATION FINDINGS:
1
2
3
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5
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7
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9
10
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13
On 11/9/22 at 3:30 PM Licensing Program Analyst (LPA) Michelle Sutton conducted a Complaint Investigation at First Lutheran Christian Preschool and met with Director Jeni Smith. During the course of the investigation, LPA inspected the facility, reviewed records, and conducted interviews. The allegation was Staff did not communicate with authorized representative. The facility staff failed to communicate with authorized representatives of unusual incidents involving a daycare children. Based on the observations and interviews which were obtained 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.

The following deficiency were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the director Jeni Smith.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle SuttonTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
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 3
Control Number 02-CC-20220916153737
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: FIRST LUTHERAN CHRISTIAN PRESCHOOL
FACILITY NUMBER: 070211160
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/23/2022
Section Cited
CCR
101223(a)(1)
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101223 Personal Rights(a) The licensee shall ensure that each child is accorded the following personal rights:(1) To be accorded dignity in his/her personal relationships with staff and other persons. This requirement is not met as evidence by;
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By POC 11/23/22 Director will submit a written statement understanding CCLD regulations for Personal Rights.
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Based on observation, interviews and record reviews, day care child was inappropriately touched by another day care child during free play. This
is an potential risk to Health and Safety or Personal Rights risk to persons in care.
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Type B
11/23/2022
Section Cited
CCR
101212(f)
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101212 Reporting Requirements (f) The items specified in (d)(1)(A) through (H) above shall also be reported to the child's authorized representative. This requirement is not met as evidence by;
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By POC 11/23/22 Director will submit a written statement understanding CCLD regulations for Reporting Requirements.
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Based on observation, interviews and record reviews, The facility staff failed to communicate with authorized representatives of unusual incidents involving a daycare children. This is an potential risk to Health and Safety or Personal Rights risk to persons in care.
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By 12/8/22 the facility will conduct staff training on Personal Rights and Reporting Requirements.
Facility will submit proof of agenda and signatures of staff present.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle SuttonTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3