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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073407440
Report Date: 10/24/2024
Date Signed: 10/24/2024 02:12:24 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 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
08/13/2024 and conducted by Evaluator Cherie Acosta
COMPLAINT CONTROL NUMBER: 02-CC-20240813141350
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:72CENSUS: 53DATE:
10/24/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Marla WatawalaTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff handled child in a rough manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced visit to investigate the above allegation. LPA met with Program Director Marla Watawala.

During the investigation LPA conducted interviews.

During interviews it was stated that the site director did handle a child in a rough manner. It was also stated that the site director yells at children in care.

Based on interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is to be substantiated.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
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 3
Control Number 02-CC-20240813141350
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: FOREST HILLS PRESCHOOL AND CHILD CARE CENTER
FACILITY NUMBER: 073407440
VISIT DATE: 10/24/2024
NARRATIVE
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The attached type A violation is cited today and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC9224). The LIC 9224 must be placed in the child's file to be reviewed by licensing.

Notice of Site Visit was provided and must be posted for 30 days.
Exit interview was conducted and report was reviewed with Marla Watawala.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 02-CC-20240813141350
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: FOREST HILLS PRESCHOOL AND CHILD CARE CENTER
FACILITY NUMBER: 073407440
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/25/2024
Section Cited
CCR
101223(a)(3)
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Personal Rights.The licensee shall ensure that each child is 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
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Facility shall develop a written plan of action to ensure there are no further incidents. Facility shall submit a copy of this plan to CCL by 10/25/24.
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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.This requirement was not met as evidenced by: site director has handled a child in a rough manner which is an immediate risk to the health and safety of children in care.
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• 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.

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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: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3