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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430700265
Report Date: 04/16/2024
Date Signed: 04/16/2024 01:08:07 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/20/2024 and conducted by Evaluator Julia Placencia
COMPLAINT CONTROL NUMBER: 52-CC-20240320131329
FACILITY NAME:GRACE LUTHERAN PRESCHOOLFACILITY NUMBER:
430700265
ADMINISTRATOR:MCDERMOTT, PENNYFACILITY TYPE:
850
ADDRESS:3149 WAVERLY STREETTELEPHONE:
(650) 493-8942
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY:24CENSUS: 19DATE:
04/16/2024
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Felicity AckersTIME COMPLETED:
01:20 PM
ALLEGATION(S):
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Staff member physically restrains children in care.
INVESTIGATION FINDINGS:
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On April 16, 2024 at 10:10am, Licensing Program Analyst (LPA) Julia Placencia arrived unannounced to complete the complaint investigation regarding the allegation above. LPA met with interim director Felicity Ackers and Pastor Matt Smuts. Director Regina Imlach is currently on leave. There were 19 children and an additional 3 staff members present. During the course of the investigation, LPA toured the facility and made observations, and also conducted interviews with staff, children and parents. It has been disclosed that director Regina Imlach has at times restrained children during time-out by sitting directly in front of a child and positioning herself in a way that prevents the child from getting out of his/her chair.

Based on observations, interviews and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22 is being cited on the attached LIC 9099D. Failure to submit Proof of Corrections (POC) by Plan of Correction date may result in additional civil penalties. ***Continued on LIC 809C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Julia Placencia
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024
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 52-CC-20240320131329
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: GRACE LUTHERAN PRESCHOOL
FACILITY NUMBER: 430700265
VISIT DATE: 04/16/2024
NARRATIVE
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The attached type A violation is cited today and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC 9224). The LIC 9224 must be placed in each child's file to be reviewed by licensing.

Exit interview conducted with Interim Director Felicity Ackers. A Notice of Site Visit was provided and must remain posted for 30 days.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Julia Placencia
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 52-CC-20240320131329
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: GRACE LUTHERAN PRESCHOOL
FACILITY NUMBER: 430700265
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/19/2024
Section Cited
CCR
101223(a)(3)
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101223(a)(3)-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...
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All staff members shall watch the CCLD video on Children’s Personal Rights in Child Care on CCLD website. Upon completion of watching video, each staff member is to write a statement ensuring children’s personal rights will not be violated and submit to LPA by due date of 4/19/24.
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This requirement is not met as evidenced by: Based on interviews, the director has restrained children during time-out by positioning herself in a way that prevents the child from getting our of his/her chair. This is an immediate health and safety and/or personal rights risk to children in care.
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 ***Additionally, director shall submit her POC upon return from leave, by due date of 4/30/24.
***Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
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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.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Julia Placencia
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/20/2024 and conducted by Evaluator Julia Placencia
COMPLAINT CONTROL NUMBER: 52-CC-20240320131329

FACILITY NAME:GRACE LUTHERAN PRESCHOOLFACILITY NUMBER:
430700265
ADMINISTRATOR:MCDERMOTT, PENNYFACILITY TYPE:
850
ADDRESS:3149 WAVERLY STREETTELEPHONE:
(650) 493-8942
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY:24CENSUS: 19DATE:
04/16/2024
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Felicity AckersTIME COMPLETED:
01:20 PM
ALLEGATION(S):
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Staff member yells at children in care.
INVESTIGATION FINDINGS:
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On April 16, 2024 at 10:10am, Licensing Program Analyst (LPA) Julia Placencia arrived unannounced to complete the complaint investigation regarding the allegation above. LPA met with Interim Director Felicity Ackers and Pastor Matt Smuts. Director Regina Imlach is currently on leave. There were 19 children and an additional 3 staff members present.

During the course of the investigation, LPA toured the facility and made observations, and also conducted interviews with staff, children and parents. There is not enough evidence to prove if the allegation that the director yells, or speaks in an inappropriate tone, is true or false.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted with Interim Director Felicity Ackers. A Notice of Site Visit was provided and must be posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Julia Placencia
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/20/2024 and conducted by Evaluator Julia Placencia
COMPLAINT CONTROL NUMBER: 52-CC-20240320131329

FACILITY NAME:GRACE LUTHERAN PRESCHOOLFACILITY NUMBER:
430700265
ADMINISTRATOR:MCDERMOTT, PENNYFACILITY TYPE:
850
ADDRESS:3149 WAVERLY STREETTELEPHONE:
(650) 493-8942
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY:24CENSUS: 19DATE:
04/16/2024
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Felicity AckersTIME COMPLETED:
01:20 PM
ALLEGATION(S):
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Staff member uses inappropriate forms of punishment for children in care.
INVESTIGATION FINDINGS:
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On April 16, 2024 at 10:10am, Licensing Program Analyst (LPA) Julia Placencia arrived unannounced to complete the complaint investigation regarding the allegation above. LPA met with Interim Director Felicity Ackers and Pastor Matt Smuts. Director Regina Imlach is currently on leave. There were 19 children and an additional 3 staff members present.

During the course of the investigation, LPA toured the facility and made observations, and also conducted interviews with staff, children and parents. There is not enough evidence to prove if this allegation is true or false.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted with Interim Director Felicity Ackers. A Notice of Site Visit was provided and must be posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Julia Placencia
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 5