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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073407440
Report Date: 06/02/2022
Date Signed: 06/02/2022 11:22:12 AM

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
03/17/2022 and conducted by Evaluator Phyllis Dyer
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20220317092014
FACILITY NAME:FOREST HILLS PRESCHOOL AND CHILD CARE CENTERFACILITY NUMBER:
073407440
ADMINISTRATOR:WATAWALA, MARLAFACILITY TYPE:
850
ADDRESS:127 MIDHILL RDTELEPHONE:
(925) 228-0611
CITY:MARTINEZSTATE: CAZIP CODE:
94553
CAPACITY:78CENSUS: 16DATE:
06/02/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Marla Watawala TIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights - Child was injured while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LPA Dyer conducted an unannounced complaint inspection to deliver the findings of the above allegation. It was alleged that Child was injured while in care. Today the director, 3 staff and 16 children are present.
Staff state the child’s hair was combed after nap and an injury was noted. Staff deny observing anyone (staff or children) violating the child’s personal rights while the child was in care. Staff reported the injury as soon as it was observed. The injury was discussed with the parent when they arrived to pick up the child. Neither staff or the parents were able to determine exactly how, when and/or where the injury actually took place.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. Therefore, the allegation is Unsubstantiated. Exit interview conducted. Appeal rights were discussed and given. This report must be kept available for public review for 3 years. Notice of Site Visit was posted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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