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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073407454
Report Date: 05/31/2019
Date Signed: 05/31/2019 12:18:44 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
05/24/2019 and conducted by Evaluator Ronda Hollie
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20190524142520
FACILITY NAME:LITTLE FLOWERS MONTESSORI - MITCHELLFACILITY NUMBER:
073407454
ADMINISTRATOR:MELODY ANGLESFACILITY TYPE:
850
ADDRESS:2875 MITCHELL DRTELEPHONE:
(925) 322-0135
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:144CENSUS: 64DATE:
05/31/2019
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Melody AnglesTIME COMPLETED:
12:50 PM
ALLEGATION(S):
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PERSONAL RIGHTS Staff grabbed a child and left a mark
INVESTIGATION FINDINGS:
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 Licensing Program Analyst's,(LPA's), R. Hollie & L. Chew, conducted an unannounced complaint inspection with Director, M. Angles, to discuss the above allegation. LPA's conducted a tour of the facility and obtained a census. Interviews were conducted and files were reviewed.
Based on the interviews, the allegation is true, that a staff member grabbed a child by the back of their clothing an scratched the back of the child's neck, leaving a mark, therefore, the allegation of Personal Rights violation is SUBSTANTIATED. Because this is a second violation of Personal Rights within a one year period, the facility will be charged a Civil Penalty today $1000.00.

PLEASE SEE 9099-C AND 9099-D FOR CONTINUED REPORT
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Anika EvansTELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Ronda HollieTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2019
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 5
Control Number 02-CC-20190524142520
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: LITTLE FLOWERS MONTESSORI - MITCHELL
FACILITY NUMBER: 073407454
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/31/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/03/2019
Section Cited
CCR
101223a2
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101223a2 Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights: (2)To be accorded SAFE, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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The Facility will place in writing, how they will ensure that children receive safe and healhful treatment from staff and their Personal Rights are not violated. LPA is recommending that the facility meet with Management Staff to discuss further ways to assist the facility, prior to taking legal action against the facility.
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The above requirement is not being met. as evidenced by interviews in where a child was scratched on the back of the neck as a teacher pulled at his clothing while he was running. This type of action is an immediate risk to children in care. This is the second such Personal right's Violation of children within the last one year. The facility will receive a Civil Penalty of $1000.
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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: Anika EvansTELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Ronda HollieTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2019
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
05/24/2019 and conducted by Evaluator Ronda Hollie
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20190524142520

FACILITY NAME:LITTLE FLOWERS MONTESSORI - MITCHELLFACILITY NUMBER:
073407454
ADMINISTRATOR:MELODY ANGLESFACILITY TYPE:
850
ADDRESS:2875 MITCHELL DRTELEPHONE:
(925) 322-0135
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:144CENSUS: 64DATE:
05/31/2019
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Melody AnglesTIME COMPLETED:
12:50 PM
ALLEGATION(S):
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REPORTING REQUIREMENTS - Incident was not reported
INVESTIGATION FINDINGS:
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Licensing Program Analyst's,(LPA's), R. Hollie & L. Chew, conducted an unannounced complaint inspection with Director, M. Angles, to discuss the above allegation. LPA's conducted a tour of the facility and obtained a census. Interviews were conducted and files were reviewed.
Based on the interview with the Director, the allegation is true and therefore, SUBSTANTIATED that an incident occurred where a staff member pulled a child's clothing while a child was running from the teacher, leaving a scratch on the child's neck. The teacher was terminated and the facility failed to report the incident as required.
PLEASE SEE 9099-D FOR DEFICIENCY.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Anika EvansTELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Ronda HollieTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 02-CC-20190524142520
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: LITTLE FLOWERS MONTESSORI - MITCHELL
FACILITY NUMBER: 073407454
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/31/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/04/2019
Section Cited
CCR
101212ad1C
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REPORTING REQUIREMENTS 101212ad1C Each licensee or applicant shall furnish to the Department reports as required by the Department including, but not limited to, the following: upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. Events reported shall include the following: Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.


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The licensee will submit an unusual incident report to CCL no later than 06-04-19. Additionally, the licensee will informed the child's parents, in writing, to what occurred in detail and how the incident was resolved. The facility will send LPA a copy of what is given to the parent's no later than June 4, 2019.
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This requirement is not being met as evidenced by the interview conducted. The licensee failed to report a staff member grabbed a child by their clothing, resulting in a mark left neck on the child's neck. Although the facility terminated the staff member, the facility failed to report the incident as required.
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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: Anika EvansTELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Ronda HollieTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2019
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 02-CC-20190524142520
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: LITTLE FLOWERS MONTESSORI - MITCHELL
FACILITY NUMBER: 073407454
VISIT DATE: 05/31/2019
NARRATIVE
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 THE LICENSEE MUST GIVE EACH PARENT OF CHILDREN IN CARE, AND NEWLY ENROLLING PARENTS, FOR THE NEXT ONE YEAR, A COPY OF THIS REPORT. PARENT'S SHALL SIGN A LIC 9224, AN ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS AND THE FORM SHALL BE PLACED IN CHILDREN'S FILES. THE LICENSEE SHALL POST THIS REPORT FOR PUBLIC VIEWING FOR THE NEXT 30 DAYS.
PLEASE SEE 9099-D FOR DEFICIENCIES.

PARENTS SHALL BE GIVEN ALL THREE REPORTS AND THE LIC 9224 SHALL BE PLACED IN EACH CHILD'S FILE.
SUPERVISOR'S NAME: Anika EvansTELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Ronda HollieTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 5