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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343611397
Report Date: 10/24/2019
Date Signed: 10/24/2019 12:41:55 PM



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
08/08/2019 and conducted by Evaluator Kristal Goodell
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20190808134906
FACILITY NAME:LINCOLN PLAZA MONTESSORIFACILITY NUMBER:
343611397
ADMINISTRATOR:JACOBSON, BRENDAFACILITY TYPE:
850
ADDRESS:400 Q STREET, #1704TELEPHONE:
(916) 795-4111
CITY:SACRAMENTOSTATE: CAZIP CODE:
95814
CAPACITY:59CENSUS: 50DATE:
10/24/2019
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Brenda JacobsonTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Personal Rights: Staff handled daycare child roughly.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Goodell and Pascual met with Director Brenda Jacobson to deliver findings regarding the above allegation. Upon arrival, LPA conducted a census of 34 preschool children with 4 staff. LPA also observed 16 toddler children with 4 staff. It was alleged that a staff member pulled a child’s arm and grabbed child’s face. During the investigation, LPA Goodell conducted observations among children and staff. LPA also obtained documentation regarding facility’s policy on redirection and recent staff trainings. LPA conducted interviews with children, parents and staff. Interviews disclosed that staff re-direct children and provide alternative activities. There was no corroborating information that a child’s arm was pulled. LPA learned that child #1 reported to staff and parents that Staff #1 grabbed child by the chin. Staff #1 denied grabbing child’s face but admitted that on occasion they have placed both hands on a child’s face to direct or gain attention with no intention of harming children. However, the incident regarding the allegation was witnessed by a second staff member. Therefore, LPA determined through interviews that an incident resulted in a child’s personal rights violated which poses a potential risk to children in care. As a result, the above allegation is SUBSTANTIATED. Title 22 deficiency have been cited on the attached LIC 9099-D. Report reviewed and discussed with director. A notice of site visit issued and must remain posted for 30 days. Appeal Rights were also issued and discussed.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kristal GoodellTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2019
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 3
Control Number 03-CC-20190808134906
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: LINCOLN PLAZA MONTESSORI
FACILITY NUMBER: 343611397
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/28/2019
Section Cited
CCR
101223(a)(3)
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Personal Rights. To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or
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Director acknowledged requirement and stated facility provides bi-monthly staff training regarding redirecting children.Director also stated all staff meeting will be conducted on 10/24/19 which will address Personal Rights. Proof of training will be submitted to LPA by POC due date 10/28/19.
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withholding of shelter, clothing, medication or aids to physical functioning. This requirement is not met due to during the investigation LPA LPA determined through interviews that an incident resulted in a child’s personal rights violated which poses a potential 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: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kristal GoodellTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
08/08/2019 and conducted by Evaluator Kristal Goodell
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20190808134906

FACILITY NAME:LINCOLN PLAZA MONTESSORIFACILITY NUMBER:
343611397
ADMINISTRATOR:JACOBSON, BRENDAFACILITY TYPE:
850
ADDRESS:400 Q STREET, #1704TELEPHONE:
(916) 795-4111
CITY:SACRAMENTOSTATE: CAZIP CODE:
95814
CAPACITY:59CENSUS: 50DATE:
10/24/2019
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Brenda JacobsonTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Reporting Requirements: Staff failed to inform authorized representative about an incident.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Goodell and Pascual met with Director Brenda Jacobson to deliver findings regarding the above allegation. Upon arrival, LPA conducted a census of 34 preschool children with 4 staff. LPA also observed 16 toddler children with 4 staff. It was alleged that staff failed to inform parents about an incident. During the investigation LPA Goodell obtained documents related to the facility’s policy reporting requirements. Interviews with children, parents and staff were also conducted. LPA learned through interviews with children, parents and staff that incidents are documented, and copies of Incident Reports issued to parents. LPA also learned that the alleged incident did occur, parents were informed by the child and the incident was discussed with staff during pick up day of incident. Therefore, based on the conflicting information obtained during interviews and documentation, LPA was unable to determine if a reporting requirement violation occurred. As a result, the allegation is UNSUBSTANTIATED.

Report reviewed and discussed with director. A notice of site visit issued and must remain posted for 30 days. Appeal Rights were also issued and discussed.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kristal GoodellTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2019
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 3