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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340306383
Report Date: 05/23/2023
Date Signed: 05/23/2023 11:36:35 AM

Document Has Been Signed on 05/23/2023 11:36 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:MARVIN MARSHALL CHILDREN'S CENTERFACILITY NUMBER:
340306383
ADMINISTRATOR:VONG,JACK,MANI, REYNOLDSFACILITY TYPE:
850
ADDRESS:5309 KENNETH AVENUETELEPHONE:
(916) 971-7380
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 209TOTAL ENROLLED CHILDREN: 209CENSUS: 109DATE:
05/23/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Lisa TealTIME COMPLETED:
11:45 AM
NARRATIVE
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On May 23, 2023 at approximately 9:45 AM, Licensing Program Analyst (LPA) Josiah Gathing met with ECE Program Manager Lisa Teal and ECE Administrator Meghan Jorgensen for an unannounced Case Management Inspection regarding a self-reported incident provided to the Licensing Program.

The initial report provided to licensing by the facility stated that Administration observed a video taken in the classroom showing a teacher restraining a child. The reason for the report was an aggressive act by a staff member. During the investigation, LPA toured the facility, conducted an interview, and reviewed video footage related to the incident. Program Manager interview confirmed that the teacher has been placed on leave since the video was observed on April 25, 2023 and the teacher is to be permanently terminated from employment once the internal investigation has been completed. Program Manager stated that the teacher in question had not been written up in the past and had never previously required disciplinary action. LPA was allowed to review video footage and visually confirmed that the child was restrained in an aggressive manner in this instance.

Today's investigation revealed a preponderance of evidence to suggest that the incident occurred as reported.


Cont. on LIC 809-C...
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/23/2023 11:36 AM - It Cannot Be Edited


Created By: Josiah Gathing On 05/23/2023 at 10:53 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: MARVIN MARSHALL CHILDREN'S CENTER
FACILITY NUMBER: 340306383

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/24/2023
Section Cited
CCR
101223(a)(3)

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101223 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...
This requirement was not met as evidenced by:
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The individual responsible for the incident is no longer employed with this facility.
Facility administrators will notify all parents of currently enrolled children, as well as newly enrolled families in the next 12 months of this citation.
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Based on interviews and record review the facility did not comply with the above regulation as a child was handled in a rough manner which poses Health, Safety, or Personal Rights risk to persons 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:Seychelle De Luca
LICENSING EVALUATOR NAME:Josiah Gathing
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2023


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: MARVIN MARSHALL CHILDREN'S CENTER
FACILITY NUMBER: 340306383
VISIT DATE: 05/23/2023
NARRATIVE
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Title 22 deficiencies are cited on the subsequent pages of this report. Program Manager acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 809-D with Type A deficiencies for 30 days 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. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee. LIC 9224 and Appeal Rights were provided. Program Manager's signature on this report acknowledges receipt of these rights.

This report was reviewed and a printed copy was provided to the Program Manager. A Notice of Site Visit was provided and shall remain posted for a period of 30 days.

Parents/guardians must acknowledge receipt of this report and citation by signing a LIC9224,

“ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS”. A copy of this form should be placed in each child's file upon receipt from parent.

A Type A deficiency is cited with details on the LIC 809-D page.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023
LIC809 (FAS) - (06/04)
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