073406632-11-22-2019-02-CC-DPEZ-BKMVWG-20200108154753

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 073406632
Report Date: 11/22/2019
Date Signed: 11/22/2019 03:34:51 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
11/14/2019 and conducted by Evaluator Geneen Redmond

PUBLIC

COMPLAINT CONTROL NUMBER: 02-CC-20191114163036

FACILITY NAME:	CHILD DAY SCHOOL, LLC - LAFAYETTE		FACILITY NUMBER:	073406632
ADMINISTRATOR:	MARIA C. ASUNCION		FACILITY TYPE:	850
ADDRESS:	1049 STUART STREET		TELEPHONE:	(925) 284-7092
CITY:	LAFAYETTE	STATE: CA	ZIP CODE:	94549
CAPACITY:	83	CENSUS: 68	DATE:	11/22/2019
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Rachel Baisch, Acting Director		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff left daycare child unattended while using the restroom

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Redmond, conducted an unannounced, Complaint Investigation visit to the facility regarding the above listed allegation. During the visit, LPA met with Rachel Baisch, Acting Director.

LPA conducted interviews of staff. Based on the information obtained, a teacher, identified as S8 (actual name provided to Acting Director) took children to the restroom during a transitional period from outside/playard. After children used the restroom, S8 led the children into their classroom and left a child, (identified as) C1 in the restroom alone and unsupervised. Another teacher, found C1 and returned C1 to the class.

LPA interviewed S8. S8 claimed to have no knowledge of incident, while multiple sources verified C1 was left alone, unsupervised in the restroom by S8. Based on information

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen Redmond	TELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 02-CC-20191114163036

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: CHILD DAY SCHOOL, LLC - LAFAYETTE	FACILITY NUMBER: 073406632
	VISIT DATE: 11/22/2019

NARRATIVE

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LPA obtained during the investigation, the allegation is SUBSTANTIATED. A finding of "substantiated" means that the preponderance of evidence standard has been met.

Plan of Correction

LPA issued a deficiency and a Plan of Correction (POC) with a due date, in order for the facility to correct the issue. See LIC 9099 D for deficiency. Facility shall also do the following:

Facility has been issued a type A deficiency, (serious violation). Parents and or responsible parties shall be provided a copy of this report including the LIC 9099 and LIC 9099C.

Each parents/responsible party shall receive and sign off on the Acknowledgement of Receipt of Licensing Report form (LIC 9224) and a copy shall be placed in each child's file.

Failure to complete POC by POC due date may result in Civil Penalties of up to $100 per day, per violation.

Notice of Site Visit

LPA issued a Notice of Site Visit to signor below. Notice of Site Visit must be posted in a prominent location in facility, for 30 days, visible to parents and visitors of the facility.

Appeal Rights

LPA issued Appeal Rights to signor below. Facility has the right of appeal as discussed in the Appeal Rights.

LPA discussed Complaint Investigation Report (LIC 9099/D) with signor below.

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen Redmond	TELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019

LIC9099 (FAS) - (06/04)

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Control Number 02-CC-20191114163036

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: CHILD DAY SCHOOL, LLC - LAFAYETTE	FACILITY NUMBER: 073406632
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/22/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/25/2019 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	Responsibility for Providing Care and Supervision. No child(ren) shall be left without the supervision of a teacher at any time...(See section cited) THIS REQUIREMENT WAS NOT MET: LPA obtained information	1 2 3 4 5 6 7	Licensee shall 1) Provide a written and signed plan detailing how children will be monitored and accounted for during restroom/transitional periods. 2) Provide training to S8. Provide a
	8 9 10 11 12 13 14	that a child was left unattended and without supervision in the restroom. This is an immediate threat to the health and safety of children in care.	8 9 10 11 12 13 14	summary of training and a log with signature and dates of training to LPA by POC due date. NOTE: Failure to comply may result in Civil Penalties of up to $100 per day, per violation.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen Redmond	TELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2019

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019

LIC9099 (FAS) - (06/04)

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