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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 070215149
Report Date: 08/26/2021
Date Signed: 08/26/2021 11:05:17 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
06/29/2021 and conducted by Evaluator Paul Peterson
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20210629162201
FACILITY NAME:LA PETITE ACADEMYFACILITY NUMBER:
070215149
ADMINISTRATOR:TRAHAN, SAMANTHAFACILITY TYPE:
850
ADDRESS:4304 COWELL ROADTELEPHONE:
(925) 676-4416
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY:97CENSUS: 31DATE:
08/26/2021
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Samantha TrahanTIME COMPLETED:
11:10 AM
ALLEGATION(S):
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Staff handled child in a rough manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Paul Petersen conducted an unannounced complaint investigation site inspection for this facility. LPA met with facility director, Samantha Trahan. There were 31 preschool age children present at this facility at the time of this inspection.

Based on information gathered through interviews and a review of the facility records, it was determined that a staff person at this facility abruptly and forcefully moved a child in care at this facility in a manner which was inappropriate for the circumstances and violated the child's personal rights. There was no injury resulting from the interaction. The preponderance of evidence standard has been met and the above allegation is found to be substantiated and a Type B deficiency cited.

An exit interview was conducted with the facility director, and a plan of correction was discussed. The facility provided proof of clearance of the plan of correction during this site inspection. Appeal rights were given and reviewed. A notice of site visit was provided and is to remain posted for a period of 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 368-2672
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
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-20210629162201
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: 08/26/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/10/2021
Section Cited
CCR
101223(a)(1)
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101223(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 was not met as evidenced by an interaction between a staff person and child in care which involved the staff person abruptly
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This facility agreed to provide proof of staff training regarding the personal rights of children in care and staff-child interactions. 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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and forcefully grabbing/moving the child in an inappropriate manner posing a potential risk to the health and safety of the child.
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This facility provided proof of completion of this plan of correction while LPA was present at this site inspection. The plan of correction is cleared as of 08/26/21.
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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: Mayla MendozaTELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 368-2672
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2