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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073404524
Report Date: 05/17/2019
Date Signed: 05/17/2019 04:13:55 PM



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
02/27/2019 and conducted by Evaluator Ronda Hollie
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20190227105845
FACILITY NAME:CUSTODIO-NOMELLINI, CARMENFACILITY NUMBER:
073404524
ADMINISTRATOR:CUSTODIO-NOMELLINI, CARMENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 934-8396
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:14CENSUS: 9DATE:
05/17/2019
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Custodio-Nomellini, CarmenTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
PERSONAL RIGHTS - Licensee grabbed day care child.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Progam Analyst(LPA), R. Hollie, met with Licensee for purpose of a Complaint Inspection. There are nine children present, eight preschool children and one, seven month old infant. The Licensee is present along with two fingerprint cleared assistants, Khamille Andrea Pe and Jocelyn Lugo and her son, Gianluca Nomelini, who is visiting as of this morning and will be leaving on Tuesday to return school in LA. The Licensee understands that all person's who have contact with children must be fingerprint cleared. As a part of this investigation, LPA conducted interviews of children who were old enough to talk and a random sampling of parent's. The licensee denies grabbing children. 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 unsubstantiated. However, because this is the second allegation that the licensee has grabbed a child, LPA is recommending that the Licensee meet with CCLD's Management staff for an Informal Meeting to discuss possible causes as to why the allegation has re-occurred.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Anika EvansTELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Ronda HollieTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019
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 2
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
02/27/2019 and conducted by Evaluator Ronda Hollie
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20190227105845

FACILITY NAME:CUSTODIO-NOMELLINI, CARMENFACILITY NUMBER:
073404524
ADMINISTRATOR:CUSTODIO-NOMELLINI, CARMENFACILITY TYPE:
810
ADDRESS:3640 SUGARBERRY LANETELEPHONE:
(925) 934-8396
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:14CENSUS: 9DATE:
05/17/2019
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Custodio-Nomellini, CarmenTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
PERSONAL RIGHTS - Licensee left infant in soiled diapers resulting in infant developing diaper rash.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst(LPA), R. Hollie, met with Licensee for purpose of a Complaint Inspection. There are nine children present, eight preschool children and one, seven month old infant. The Licensee is present along with two fingerprint cleared assistants, Khamille Andrea Pe and Jocelyn Lugo and her son, Gianluca Nomelini, who is visiting as of this morning and will be leaving on Tuesday to return school in LA. The licensee stated that she changes diapers 4-5 times a day and always at the end of the day. LPA, along with the Licensee viewed the garbage and observed lots of soiled diapers. Parent's were interviewed. One parent stated that they felt that their child's diaper was not changed on two occasion's, but no diaper rash, however, other parent's stated that the Licensee always changed diapers of their children. LPA cannot prove or disprove that this allegation is true, therefore, the allegation is UNSUBSTANTIATED. However, because this is the second allegation that the licensee does not change diaper's regularly, LPA is recommending that the Licensee meet with CCLD's Management staff for an Informal Meeting to discuss possible causes as to why the allegation has re-occurred.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Anika EvansTELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Ronda HollieTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019
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 2