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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 070215149
Report Date: 12/04/2019
Date Signed: 01/13/2020 10:58:46 AM



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
11/27/2019 and conducted by Evaluator Caroline Colson
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20191127105226
FACILITY NAME:LA PETITE ACADEMYFACILITY NUMBER:
070215149
ADMINISTRATOR:FARRELL STREETAFACILITY TYPE:
850
ADDRESS:4304 COWELL ROADTELEPHONE:
(925) 676-4416
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY:97CENSUS: 30DATE:
12/04/2019
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Samantha TrahanTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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2
3
4
5
6
7
8
9
Personal Rights - Facility staff handled child in a rough manner
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst Caroline Colson met with Samantha Trahan, an administrator, regarding an unannounced complaint investigation at 11:15 AM. There are 30 preschool children and 6 staff members. Interviews revealed that there are several staff members who have handled a child in a rough manner while redirecting the child. Based on LPA's interviews which were conducted and a record review, the prepronderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, 101223(3) is being cited on the attached LIC 9099 D.

The attached type A is being cited and must be corrected by due date. All parents will need to sign the LIC 9224 and newly enrolled parents within the next 12 months. An exit interview was conducted and appeals were discussed.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Caroline ColsonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2019
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-20191127105226
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: LA PETITE ACADEMY
FACILITY NUMBER: 070215149
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/04/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/04/2019
Section Cited
CCR
101233(3)
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7
Personal Rights
To be free corporal or unusual punishement. S1 and S2 have handled children in a rough manner.
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7
Staff will review personal rights videos and provide individual summaries.
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7
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7
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7
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7
1
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7
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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.
SUPERVISOR'S NAME: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Caroline ColsonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 2