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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384002727
Report Date: 12/12/2019
Date Signed: 12/12/2019 02:50:06 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/17/2019 and conducted by Evaluator Marie Rodriguez
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20191017132200
FACILITY NAME:MARTIN LUTHER KING JR. CENTERFACILITY NUMBER:
384002727
ADMINISTRATOR:STANCIL, MADONNAFACILITY TYPE:
850
ADDRESS:200 CASHMERE STREETTELEPHONE:
(415) 401-1377
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94124
CAPACITY:38CENSUS: 27DATE:
12/12/2019
UNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Madonna Stancil and Alicia TorresTIME COMPLETED:
03:05 PM
ALLEGATION(S):
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Facility staff spanked child in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marie Rodriguez conducted an unannounced inspection to continue with Complaint investigation. LPA met with Site Director Madonna Stancil and explained purpose of inspection. Education Director ALicia Torres arrived later to discuss the findings.

During the course of the investigation, LPA conducted interviews and reviewed pertinent documents received. Facility also conducted an internal investigation. Based on the information obtained, it was found that Staff S1 spanked Child C1 on the hand in an isolated incident. Staff S1 received disciplinary action and is no longer with the facility.

Based on information gathered, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Deficiency cited today under California Code of Regulations, Title 22, Division 12, follows on LIC 9099D.

Report reviewed and discussed with Education Director Alicia Torres. Appeals Rights given and explained. A copy of report was provided. Notice of site visit was observed being posted and shall remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2019
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 2
Control Number 05-CC-20191017132200
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: MARTIN LUTHER KING JR. CENTER
FACILITY NUMBER: 384002727
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/31/2019
Section Cited
CCR
101223(a)(3)
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Personal Rights - (a) The licensee shall ensure that each child is accorded the following personal rights: (3) 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.

This requirement has not been met as evidenced by:
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Education Director stated training was provided to staff regarding Children's Personal Rights in November 2019. A copy of the Power Point presentations and staff sign in sheet was provided to LPA via email during inspection.

Staff S1 received disciplinary action and is no longer with the facility.
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Based on interviews conducted with staff and facility conducting an internal investigation, it was found that S1 spanked C1 on the hand in an isolated incident. Facility failed to ensure children were free from corporal or unusual punishment and infliction of pain which poses a potential Personal RIghts risk to children in care.
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POC cleared during inspection.
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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: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 2