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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015700612
Report Date: 04/16/2024
Date Signed: 04/16/2024 12:35:29 PM

Substantiated


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
04/11/2024 and conducted by Evaluator Melanie Otsuji
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20240411101016
FACILITY NAME:LILY OF THE VALLEY EARLY EDUCATION & PRESCHOOLFACILITY NUMBER:
015700612
ADMINISTRATOR:LOCUS, LISAFACILITY TYPE:
830
ADDRESS:348 NORTH CANYONS PARKWAYTELEPHONE:
(408) 431-9226
CITY:LIVERMORESTATE: CAZIP CODE:
94551
CAPACITY:51CENSUS: 27DATE:
04/16/2024
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Abadat Khan/Bertha TaitagueTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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-Child injured while in care
INVESTIGATION FINDINGS:
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On, 4/16/2024, Licensing Program Analysts (LPAs) Melanie Otsuji and Randy Miranda arrived to the facility unannounced to conduct initial 10 day investigation into the above allegation. LPAs met with Facility Representative, Bertha Taitague and, Abadat "Abi" Khan. Also present during today's, visit were 7 additional staff members and 27 infant aged children.
During the course of the investigation LPAs conducted interviews, made observations and reviewed video recordings. Based on interviews and video recordings LPAs determined that although facility was within ratio at the time of the incident, staff were not positoned appropriately to ensure all children in care remained under visual supervision at all times which resulted in a child in care losing their balance while reaching for a toy, they fell and bumped their mouth on a shelf. 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 with Facility Representatives, Abadat Khan and Bertha Taitague. Appeal rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
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 2
Control Number 52-CC-20240411101016
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: LILY OF THE VALLEY EARLY EDUCATION & PRESCHOOL
FACILITY NUMBER: 015700612
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/30/2024
Section Cited
CCR
101229(a)(1)
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(a) The licensee shall provide care and supervision....(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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Director is to conduct an all staff infant/toddler meeting. Training is to include active supervision techniques and how to properly position teachers within a classroom for constant visual supervision of all children in care. Agenda items along with signatures of all attendees to be submitted via email to
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This requirement is not being met as evidence by: Staff were not positoned appropriately to ensure all children in care remained under visual supervision resulting in a child in care getting injured which is a potential health and safety risk to persons in care.
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LPA no later than 4/30/2024.
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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: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
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)
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