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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434410805
Report Date: 01/10/2022
Date Signed: 01/10/2022 02:10:01 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 STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/07/2021 and conducted by Evaluator Melanie Otsuji
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20211007091515
FACILITY NAME:T'ENNA PRESCHOOL AT THE OSHMAN FAMILY JCCFACILITY NUMBER:
434410805
ADMINISTRATOR:MYKENZIE BUSSERFACILITY TYPE:
850
ADDRESS:3921 FABIAN WAYTELEPHONE:
(650) 223-8788
CITY:PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY:250CENSUS: DATE:
01/10/2022
UNANNOUNCEDTIME BEGAN:
09:52 AM
MET WITH:Lauren BermanTIME COMPLETED:
10:35 AM
ALLEGATION(S):
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- Child in care isolated from others.
INVESTIGATION FINDINGS:
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**THIS REPORT WAS CONDUCTED ELECTRONICALLY DUE TO THE COVID-19 PANDEMIC**

Licensing Program Analyst (LPA) Melanie Otsuji spoke with Senior Director of Early Childhood Education, Lauren Berman.

During the course of the investigation, LPA conducted interviews and collected documentation. Based on documentation and interviews it is stated that C1 was placed into a classroom and provided 1 on 1 care separate away from C1's usual class and classmates. Although the facility had good intentions by ensuring C1's classmates were provided safe and comfortable accomodations and allowing C1 to remain on campus so C1's authorized representatives had someone to watch their child that day, it was against C1's personal rights to isolate C1 away from others. C1 should have been picked up by authorized representative's immediately. Based on LPAs observations and interviews which were conducted 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, Division 12 & Chapter 1), are being cited on the attached LIC. 9099D.
Exit interview conducted. Appeal rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie OtsujiTELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2022
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 52-CC-20211007091515
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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: T'ENNA PRESCHOOL AT THE OSHMAN FAMILY JCC
FACILITY NUMBER: 434410805
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/10/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/10/2022
Section Cited
CCR
101223(a)(1)
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(a) (1)The licensee shall ensure that each child is accorded the following personal rights:
To be accorded dignity in his/her personal relationships with staff and other persons.
This requirement is not being met as evidence by: Although the facility had good intentions by ensuring C1's classmates were provided safe and comfortable accommodations and allowing
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Director is to provide a training to all staff on the importance of ensuring children's personal rights are not violated. Topics covered and signatures of staff in attendance to be submitted to LPA no later than 2/10/2022.
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C1 to remain on campus so C1's authorized representatives had someone to watch their child that day, it was against C1's personal rights to isolate C1 away from others. This poses a potential health & safety 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: Wynn NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie OtsujiTELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3