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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 070206070
Report Date: 01/09/2023
Date Signed: 01/09/2023 02:01:40 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, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/14/2022 and conducted by Evaluator Monica Mathur
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20221214100248
FACILITY NAME:KING'S VALLEY PRESCHOOLFACILITY NUMBER:
070206070
ADMINISTRATOR:KETNER, MICHELEFACILITY TYPE:
850
ADDRESS:4255 CLAYTON ROADTELEPHONE:
(925) 687-2020
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY:120CENSUS: 54DATE:
01/09/2023
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:MIchele KetnerTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Personal Rights - Staff do not meet daycare child's toileting needs
INVESTIGATION FINDINGS:
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On 1/9/23 at 12:45 pm Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Subsequent Complaint Investigation at King’s Valley Preschool. LPA met with Director, Michelle Ketner and explained purpose of today’s investigation. Finding for the above allegation was delivered.

Complainant alleges that staff did not meet child's toileting needs. During the course of the investigation, LPA inspected the facility, reviewed records, conducted interviews and obtained documents. It was determined that on 12/12/22 child 1 (C1) played outside where yard was wet after recent rains and got wet twice that day. C1 was changed the first time but second time, when Staff 1 (S1) attempted to change clothes, she found C1 did not have extra clothes. S1 is a new hire; was unaware facility keeps their own extra stash of clothes.
continued on 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023
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 02-CC-20221214100248
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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: KING'S VALLEY PRESCHOOL
FACILITY NUMBER: 070206070
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/16/2023
Section Cited
CCR
101223(a)(2)
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101223 Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement is not met as evidenced by:
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By POC Due Date 1/16/23 Director agreed to:
1. submit written plan on how facility will ensure compliance
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Per investigation it is determined C1 got wet playing outside. S1 attempted to change clothes but C1 had ran out of extras. At least 2 staff were aware C1 was wet, but failed to change C1 who went home in wet clothes. This is a potential risk to health/safety of child/ren in care.
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2. conduct staff meeting, discuss staff communcations, training on personal rights, watch training videos on CCL website. Director shall submit verification of meeting, attendance and agenda discussed.
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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: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 02-CC-20221214100248
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: KING'S VALLEY PRESCHOOL
FACILITY NUMBER: 070206070
VISIT DATE: 01/09/2023
NARRATIVE
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It was determined at least 2 staff including S1 were aware C1 was wet but failed to change child into dry clothes, and C1 went home in wet clothes. This is a violation of Personal Rights and posed a potential risk to health and safety.

Based on the interviews and information obtained throughout the investigation, the preponderance of evidence standard has been met. Therefore, the allegation is SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 is being cited on 9099-D page.

Exit interview was conducted with Director, Michelle Ketner.
A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 DAYS
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3