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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 070213244
Report Date: 10/17/2019
Date Signed: 10/17/2019 03:40:24 PM



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
10/11/2019 and conducted by Evaluator Geneen Redmond
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20191011151920
FACILITY NAME:CALVARY CHRISTIAN SCHOOLFACILITY NUMBER:
070213244
ADMINISTRATOR:MULLENS, AMYFACILITY TYPE:
850
ADDRESS:3425 CONCORD BLVD.TELEPHONE:
(925) 682-6728
CITY:CONCORDSTATE: CAZIP CODE:
94519
CAPACITY:92CENSUS: DATE:
10/17/2019
UNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Mullens, Amy, DirectorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Physical Plant

- Facility fence is in disrepair

- Desk (where parent's sign/out sheets are kept) has a missing knob, screw exposed

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Redmond, conducted an unannouced, Complaint Investigation visit regarding the above listed allegations. During the visit, LPA met with Mullens, Amy, Director.

Allegation: Facility fence is in disrepair: LPA conducted an inspection of the facility's fence, which, encloses the children's play yard and separates two of the yards. LPA also inspected the gate, seperating the two yards. LPA observed that the fence, which is chain link, has sharp, pointed edges, running along the bottom and tops of various portions of the fence, including the gate. This allegation is - SUBSTANTIATED

Allegation: Desk where sign/out has a missing knob, screw exposed. LPA observed a knob missing, from the desk, with a screw exposed. This allegation is - SUBSTANTIATED
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen RedmondTELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019
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-20191011151920
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: CALVARY CHRISTIAN SCHOOL
FACILITY NUMBER: 070213244
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/17/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/18/2019
Section Cited
CCR
101238(a)
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Buildings and Grounds:(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. THIS REQUIREMENT WAS
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LICENSEE SHALL: 1. Repair or replace chain link fence where sharp edges are accessible to children. 2. Provide evidence of correction to LPA by POC due date. NOTE: Failure to correct POC's by due date, may res-
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NOT MET. LPA OBSERVED: That the fence, which is chain link, has sharp, pointed edges, running along the bottom and tops of various portions of the fence, including the gate. This is an immediate threat to the health and safety of children if not corrected.
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ult in civil penalties of $100 per day, per violation until corrected.
Type B
10/24/2019
Section Cited
CCR
101238(a)
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Buildings and Grounds:(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. THIS REQUIREMENT WAS
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LICENSEE SHALL: 1. Repair or replace knob or 2. Replace desk. 3. Licensee shall provide evidence of correction to LPA by POC due date. NOTE: Failure to correct POC's by due date, may result in civil penalties
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NOT MET. LPA OBSERVED: That a knob missing, from the desk (where parents sign children in/out), with a screw exposed. This poses a potential risk to parents/visitors/children if not corrected.
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of $100 per day, per violation until corrected.
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: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen RedmondTELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 2