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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 340306386
Report Date: 01/24/2020
Date Signed: 02/14/2020 10:06:50 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/02/2019 and conducted by Evaluator Marea Behvand
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20191202095302
FACILITY NAME:OAK PARK PRESCHOOLFACILITY NUMBER:
340306386
ADMINISTRATOR:WILLIAMS HOWELL, DIJANAEFACILITY TYPE:
850
ADDRESS:3500 2ND AVENUETELEPHONE:
(916) 451-9498
CITY:SACRAMENTOSTATE: CAZIP CODE:
95817
CAPACITY:34CENSUS: 17DATE:
01/24/2020
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Pam MorganTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Personal Rights
- Facility Staff handled daycare child in a rough manner
INVESTIGATION FINDINGS:
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***THIS IS AN AMENDED REPORT***
Licensing Program Analyst (LPA) Marea Behvand met with Director Pam Morgan to close a complaint investigation pertaining an alleged violation of Personal Rights.
Throughout the investigation, LPA conducted interviews with Director, staff, parents, children, and obtained relevant documents. Based on interviews, LPA determined that Facility Staff #1 handled Child #1 in a rough manner by facility staff grabbing and spinning child around by their arms, positioning the child in a restraint position with the child's hand and wrists held behind their back. LPA was informed that Staff #1 was terminated as of 01/24/2020 and that remaining staff will be required to attend a mandatory training on personal rights.
Upon further investigation, LPA determined that in the matter concerning the allegation that Facility Staff handled a daycare child in an rough manner, the allegation is SUBSTANTIATED.
Continued on 9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Marea BehvandTELEPHONE: (916) 216-7793
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2020
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 3
Control Number 03-CC-20191202095302
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: OAK PARK PRESCHOOL
FACILITY NUMBER: 340306386
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
01/27/2020
Section Cited
CCR
101223(a)(2)
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Personal Rights. Each child shall be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by:
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Director will conduct a mandatory training staff on personal rights and will provide signatures to LPA by 01/27/2020.
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Based on interviews, LPA determined that Facility Staff #1 handled Child #1 in a rough manner by facility staff grabbing and spinning child around by their arms, positioning the child in a restraint position with the child's hand and wrists held behind their back.
This poses an immediate Health, Safety, or Personal Rights risk to children in care.This poses an immediate Health, Safety, or Personal Rights risk to children in care.
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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: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Marea BehvandTELEPHONE: (916) 216-7793
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 03-CC-20191202095302
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: OAK PARK PRESCHOOL
FACILITY NUMBER: 340306386
VISIT DATE: 01/24/2020
NARRATIVE
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...Continued from previous page

California Code of Regulations Title 22 are being cited on the attached LIC 9099-D.

Upon receipt, Director shall post TYPE A deficiencies and provide copies of this licensing report to parents/guardians of children who are currently enrolled as well as parents/guardians of children newly enrolled at the facility during the next 12 months.

Parents/guardians must acknowledge receipt of this report and citation by signing a LIC 9224, “ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS.” A copy of this form should be placed in each child file upon receipt from parent.

An exit interview was conducted and Appeal Rights were provided.

Notice of Site Visit was provided and instructed to be posted for 30 days.

SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Marea BehvandTELEPHONE: (916) 216-7793
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 3