<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 070206070
Report Date: 03/10/2023
Date Signed: 03/10/2023 12:04:22 PM

Unsubstantiated


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
02/07/2023 and conducted by Evaluator Cherie Acosta
COMPLAINT CONTROL NUMBER: 02-CC-20230207153442
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: 55DATE:
03/10/2023
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Micheile KetnerTIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff left daycare child in wet clothing.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LIcensing Program Analyst (LPA) Cherie Acosta conducted an unannouced visit to invetigate the above alleagtion. LPA met with Director Michelle Ketner.

It was reported that a child had wet clothing from playing outside on the wet playground and the child was not changed out of the wet clothing.
Director stated that children do play outside when the playground is wet, staff use towels to dry the play structures and children are changed out of clothing that is wet.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated.
Notice of Site Visit was provided and must be posted for 30 day.
Report was reviewed with Michelle Ketner.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023
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 5
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
02/07/2023 and conducted by Evaluator Cherie Acosta
COMPLAINT CONTROL NUMBER: 02-CC-20230207153442

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: 55DATE:
03/10/2023
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Michelle KetnerTIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Daycare child was bit by another child in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced visit to investigate the above allegation. LPA met with Director Michelle Ketner.

During the investigation LPA conducted interviews and reviewed documents. It is determined that there have been two biting incidents. During the first biting incident the child attempted to bite a child and bit the child's jacket. There were no injuries from this incident. The second biting incident resulted in an injury.

Based on interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is to be substantiated.
Notice of Site Visit was provided and must be posted for 30 days.
Exit interview and report reviewed with Michelle Ketner.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 02-CC-20230207153442
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: 03/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/17/2023
Section Cited
CCR
101223(a)(1)
1
2
3
4
5
6
7
Personal Rights. 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.
1
2
3
4
5
6
7
Director is working with the families to prevent future incident. Director shall develop a written plan of action to ensure there are no future incident. Director shall submit a copy of this plan to CCL by 3/17/23
8
9
10
11
12
13
14
This requirement was not met as evidenced by: child in care was bitten by another child in care which is a potential risk to the health and safety of children in care.
8
9
10
11
12
13
14
• Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
02/07/2023 and conducted by Evaluator Cherie Acosta
COMPLAINT CONTROL NUMBER: 02-CC-20230207153442

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: 55DATE:
03/10/2023
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Michelle KetnerTIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Daycare child was hit by another child in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced visit to investigate the above allegation. LPA met with Director Michelle Ketner.

During the investigation LPA conducted interviews and reviewed documents. It is determined that children in care have been hit by another child in care. There are no reported injuries from the hitting incidents.

Based on interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is to be substantiated.

Notice of Site Visit was provided and must be posted for 30 days.
Exit interview and report reviewed with Michelle Ketner.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 02-CC-20230207153442
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: 03/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/17/2023
Section Cited
CCR
101223(a)(1)
1
2
3
4
5
6
7
Personal Rights. 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.
1
2
3
4
5
6
7
Staff are working with children on using words instead of hitting. Director shall develop a written plan of action to ensure there are no future incident. Director shall submit a copy of this plan to CCL by 3/17/23
8
9
10
11
12
13
14
This requirement was not met as evidenced by: children in care have been hit by another child in care which is a potential risk to the health and safety of children in care.
8
9
10
11
12
13
14
Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5