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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400296
Report Date: 01/25/2022
Date Signed: 01/25/2022 12:02:24 PM

Document Has Been Signed on 01/25/2022 12:02 PM - 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:CHILDREN'S PRE-SCHOOL CENTER, THEFACILITY NUMBER:
434400296
ADMINISTRATOR:KAY ERIKSONFACILITY TYPE:
850
ADDRESS:4000 MIDDLEFIELD ROAD T-1TELEPHONE:
(650) 493-5770
CITY:PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY: 112TOTAL ENROLLED CHILDREN: 0CENSUS: 69DATE:
01/25/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:06 AM
MET WITH:Kay Erikson TIME COMPLETED:
12:15 PM
NARRATIVE
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On 1/25/2022, Licensing Program Analyst (LPA) Jonathan Williams arrived to the facility unannounced for the purposes of conducting a Case Management in response to an unusual incident reported by facility Director. LPA was met by Director, Kay Erikson, 16 fingerprint cleared and associated staff members, and 69 preschool aged children in care.

On 1/20/2022, facility Director reported an unusual incident to the Department. In the report, Director stated that a teacher at the facility behaved inappropriately towards a child. Director stated that said teacher was observed on 1/29/2022 to "shake" a child's cot "in a harsh way" in order to force a napping child to leave the cot after naptime. Director stated that this action caused the child to cry uncontrollably. Director additionally stated that the same teacher had used an inappropriately harsh and "punitive" tone towards daycare children.

Director is advised that CCR 101223(a)(3) states that daycare children must be accorded the following 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 withholding of shelter, clothing, medication or aids to physical functioning."

Type A deficiency is cited pursuant to CCR 101223(a)(3). Director was advised LIC9224 must be delivered to and signed by all current parents of children and parents of all children subsequently enrolled for a period of 12 months from today's date.

Exit interview conducted. Appeal rights provided.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE: DATE: 01/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/25/2022
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 01/25/2022 12:02 PM - It Cannot Be Edited


Created By: Jonathan Williams On 01/25/2022 at 11:06 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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: CHILDREN'S PRE-SCHOOL CENTER, THE
FACILITY NUMBER: 434400296

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/25/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/25/2022
Section Cited
CCR
101223(a)(3)

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(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 including but not limited to: interference wiith... sleeping...
This requirement was not met as evidenced by:
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Director produced paperwork detailing disciplinary actions taken against the teacher who acted inappropriately towards daycare children. Deficiency cleared.
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Director stated that facility teacher forced a child to leave a sleeping cot and used inappropriate tones of voice (described as "harsh" and "punitive") towards daycare children. This poses an immediate risk to the health and safety of 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 Norona
LICENSING EVALUATOR NAME:Jonathan Williams
LICENSING EVALUATOR SIGNATURE:
DATE: 01/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/25/2022


LIC809 (FAS) - (06/04)
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