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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434400296
Report Date: 01/18/2022
Date Signed: 01/18/2022 01:09:08 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
01/13/2022 and conducted by Evaluator Briana Plumboy
COMPLAINT CONTROL NUMBER: 52-CC-20220113120011
FACILITY NAME:CHILDREN'S PRE-SCHOOL CENTER, THEFACILITY NUMBER:
434400296
ADMINISTRATOR:KAY ERIKSONFACILITY TYPE:
850
ADDRESS:4000 MIDDLEFIELD ROAD T-1TELEPHONE:
(650) 493-5770
CITY:PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY:112CENSUS: 44DATE:
01/18/2022
UNANNOUNCEDTIME BEGAN:
12:11 PM
MET WITH:Kay EriksonTIME COMPLETED:
01:25 PM
ALLEGATION(S):
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Personal Rights- Staff roughly handled child in care
INVESTIGATION FINDINGS:
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On 1/18/22 at 12:11pm, Licensing Program Analyst (LPA) B. Plumboy met with center Director Kay Erikson for the purpose of an UNANNOUNCED COMPLAINT INSPECTION. Present for this inspection was 44 children and 12 staff.
The allegation a staff handled a child roughly in August 2021 has been substantiated. The center self reported the incident to CCLD. As a result of T1 handling a child rough, T1's employment was terminated by The Children's Pre-School Center on August 27, 2021. Based on LPA’s record review and interview, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. Title 22, Division 12 & Chapter 1 being cited on the attached LIC. 9099D. A notice of site visit was given and must remain posted for 30 days. Appeal Rights were given and discussed. An exit interview was conducted.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2022
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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Control Number 52-CC-20220113120011
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: CHILDREN'S PRE-SCHOOL CENTER, THE
FACILITY NUMBER: 434400296
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/19/2022
Section Cited
CCR
101223(a)(1)
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To be accorded dignity in his/her personal relationships with staff and other persons.
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Staff member T1's employment was terminated on August 27, 2021
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This requirement is not met as evidenced by a staff member (T1) handled a child in a rough manner which poses a potential health and safety risk to 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: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2