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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 070215151
Report Date: 06/26/2019
Date Signed: 06/26/2019 04:41:32 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
06/20/2019 and conducted by Evaluator Geneen Redmond
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20190620135903
FACILITY NAME:LA PETITE ACADEMY, INC.FACILITY NUMBER:
070215151
ADMINISTRATOR:FARRELL, STREETAFACILITY TYPE:
840
ADDRESS:4304 COWELL ROADTELEPHONE:
(925) 676-4416
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY:30CENSUS: 53DATE:
06/26/2019
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Angela Kavert, Assistant DirectorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Personal Rights - Facility failed to notify authorized representative of incidents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Redmond, conducted an unannounced, Complaint Investigation visit on this date regarding the above listed allegation. LPA met with Angela Kavert, Assistant Director regarding the allegtions. There are two allegations under Personal Rights, one of which, is addressed below (see LIC 9099A for other report):

LPA requested and reviewed children's files and conducted an interview of staff. Based on LPA's review of files and interviews, LPA has completed the investigation and concluded the following:

A review of records for a child (C2), who attends the child care and has been identified as the subject of hitting and injuring other children at the childcare, per the records, the child has repeatedly hit, bitten, thrown items and acted "violently" towards other children or teachers. While there are Incident Reports on file in C2's file, there are no reports on file for a child who was injured by C2. Per documentation, the parent was not notified by facility staff until asking staff about the injuries on C1. - CONTINUED ON LIC 9099C
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: 06/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2019
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 6
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
06/20/2019 and conducted by Evaluator Geneen Redmond
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20190620135903

FACILITY NAME:LA PETITE ACADEMY, INC.FACILITY NUMBER:
070215151
ADMINISTRATOR:FARRELL, STREETAFACILITY TYPE:
840
ADDRESS:4304 COWELL ROADTELEPHONE:
(925) 676-4416
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY:30CENSUS: 53DATE:
06/26/2019
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Angela Kavert, Assistant DirectorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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9
Personal Rights: Facility staff failed to pick up child from school in a timely manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Redmond, conducted an unannounced, Complaint Investigation visit on this date regarding the above listed allegation. LPA met with Angela Kavert, Assistant Director regarding the allegtions. There are two allegations under Personal Rights, one of which, is addressed below (see LIC 9099 for other report):

LPA reviewed childen records and interviewed staff and parents. Per these interviews and admission by Ms. Kavert, there are times during the child care school bus/van is late picking up children from school.

Per the day care's Family Handbook, the day care center provides pick up and drop off as a part of it's services to parents upon the children's release from school. Once children are released from school, it is the child care's responsibility for the child's care. Based on LPA interviews and review of records, and conducted interviews, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be - SUBSTANTIATED - CONTINUED ON LIC 9099C
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: 06/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 02-CC-20190620135903
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, INC.
FACILITY NUMBER: 070215151
VISIT DATE: 06/26/2019
NARRATIVE
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According to California Code of Regulations, (Title 22, Division 12) violation of the section cited is a deficiency for which, a Plan of Correction (POC) has been issued on the attached LIC 9099 D. The deficiency is a Type A and must be corrected by the POC due date. Failure to correct the deficiency by POC due date may result in Civil Penalties of up to $100 per day, per violation.

Upon receipt of the POC, Licensee shall post and provide copies of this Complaint Investigation Report (LIC 9099/D) to parents/guardians of children in care at the facility. The LIC 9099/D must also be provided to parents/guardians newly enrolled at the facility during the next twelve (12) months.

All parents/guardians must sign an acknowledgement of receipt form (LIC 9224). The LIC 9224 form must be placed in each child’s filed to be reviewed by Licensing.

The LIC 9099/D, was provided and discussed with the signor below as part of an exit interview. Additionally, Appeal Rights were provided and discussed with signor.

A Notice of Site visit was posted at the time of the inspection and must remain posted for 30 days or the facility will be subject to Civil Penalties.
Send POC corrections with your FACILITY NUMBER to:

Attn: LPA Redmond

US Mail: Mailing address on top, right, first page.

Fax number: (510) 622-2641
SUPERVISOR'S NAME: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen RedmondTELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 02-CC-20190620135903
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, INC.
FACILITY NUMBER: 070215151
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
06/27/2019
Section Cited
CCR
101229(a)(1)
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Responsibility for Providing Care and Supervision he licensee shall provide care and supervision as necessary to meet the children's needs. THIS REQUIREMENT WAS NOT MET. FACILITY STAFF WAS LATE PICKING UP C1 FROM SCHOOL ON MORE THAN ONE OCCASSION. THIS IS AN IMMED-
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Licensee will: 1) Provide a statement of how the child care will ensure that children are picked up from school in a timely manner.

2) Provide training training with the date, time and signatures of all staff attending the training to LPA by POC due date.
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IATE THREAT TO THE HEALTH AND SAFETY OF CHILDREN IN CARE.
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NOTE: FAILURE TO COMPLETE POC BY POC DUE DATE MAY RESULT IN CIVIL PENALTIES OF $100 PER DAY, PER VIOLATION.
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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: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen RedmondTELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 02-CC-20190620135903
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, INC.
FACILITY NUMBER: 070215151
VISIT DATE: 06/26/2019
NARRATIVE
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Per interviews of staff, the policy/procedures of the facility is to notify both parents involving an incident where one child hits or injures another child. Both children's parents should receive a copy of the Incident Report and both parents are signatures are obtained on the Incident Report. However, LPA observed that there was no copy of Incident Reports in C1's file, in spite of him being injured on multiple occasions by C2.
Based on the LPA’s observations, review of records, and conducted interviews, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be - SUBSTANTIATED.

According to California Code of Regulations, (Title 22, Division 12) violation of the section cited is a deficiency, for which, a Plan of Correction (POC) has been issued as documented on the attached LIC 9099 D. The deficiency is a Type A, an immediate risk and must be corrected by the POC due date. Failure to correct the deficiency by POC due date may result in Civil Penalties of up to $100 per day, per violation.

Upon receipt of the POC, Licensee shall provide copies of this Complaint Investigation Report (LIC 9099/D) to parents/guardians of children in care at the facility. The LIC 9099/D must also be provided to parents/guardians newly enrolled at the facility during the next twelve (12) months.

All parents/guardians must sign an Acknowledgement of Receipt form (LIC 9224). The LIC 9224 form must be placed in each child’s filed to be reviewed by Licensing.

The LIC 9099/D, was provided and discussed with the signor below as part of an exit interview. Additionally, Appeal Rights were provided and discussed with signor.

A Notice of Site Visit was issued and shall be posted at the time of the inspection and must remain posted for 30 days or the facility will be subject to Civil Penalties.
Send POC corrections INCLUDE YOUR FACILITY NUMBER to: Attn: LPA Redmond

US Mail: Mailing address on top, right, corner, first page. Fax number: (510) 622-2641
SUPERVISOR'S NAME: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen RedmondTELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 02-CC-20190620135903
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, INC.
FACILITY NUMBER: 070215151
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
06/27/2019
Section Cited
CCR
101226.3(b)
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(b) Any unusual behavior, any injury or signs of illness requiring assessment and/or administration of first aid by staff shall be reported to the child's authorized representative and recorded in the child's record. THIS REQUIREMENT WAS NOT MET. LPA INTERVIEWS REVIEW OF RECORDS
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Licensee will: 1) Provide reporting requirement training to all staff. 2) Provide a copy of a summary of training with the date, time and signatures of all staff attending the training to LPA by POC due date.
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DETERMINED THAT (C2) HIT/INJURED (C1) ON MULTIPLE OCCASSIONS AND C1'S AUTHORIZED REPRESENTATIVE WAS NOT NOTIFIED. THERE IS NO EVIDENCE OF INCIDENT REPORT ON FILE FOR C1. THIS IS AN IMMEDIATE THREAT TO THE HEALTH AND SAFETY OF CHILDREN IN CARE.
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NOTE: FAILURE TO COMPLETE POC BY POC DUE DATE MAY RESULT IN CIVIL PENALTIES OF $100 PER DAY, PER VIOLATION.
CCR
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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: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen RedmondTELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019
LIC9099 (FAS) - (06/04)
Page: 6 of 6