073404524-2-22-2021-02-CC-SJON-BYPPGD-20210301101808

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 073404524
Report Date: 02/22/2021
Date Signed: 02/22/2021 10:45:38 AM

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
01/04/2021 and conducted by Evaluator Monica Mathur

PUBLIC

COMPLAINT CONTROL NUMBER: 02-CC-20210104140002

FACILITY NAME:	CUSTODIO-NOMELLINI, CARMEN		FACILITY NUMBER:	073404524
ADMINISTRATOR:	CUSTODIO-NOMELLINI, CARMEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 934-8396
CITY:	WALNUT CREEK	STATE: CA	ZIP CODE:	94598
CAPACITY:	14	CENSUS: 3	DATE:	02/22/2021
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Carmen Custodio-Nomellini		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Family contract terminated as a form of retaliation

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 02/22/21 at 10:15 AM Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Subsequent Complaint Investigation at Carmen Custodio-Nomellini’s family day care. Investigation was conducted via phone call due to COVID-19 restrictions. LPA met with Licensee, Carmen and explained the purpose of today’s investigation. The finding for the above allegation was also delivered during the investigation. Present in the home were Licensee and 3 children.

During the course of the investigation LPA completed an inspection of the family day care, reviewed facility records and conducted interviews. It was disclosed that Licensee and a parent had a disagreement involving a child’s personal rights. Licensee admitted she made specific comments that were deemed racist and culturally inappropriate by the parent, but also stated her intention were not malicious or meant to be racist and biased. Licensee explained the parent contract was terminated because parent seemed unsatisfied with the day care services and due to several disagreements with the family, Licensee did not feel continued service would work out anymore. Licensee was reminded on this day to be mindful when making comments that could been interpreted as racist to parents concerning their children. Licensee stated she understood.

CONTINUED ON NEXT PAGE 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 725-5998
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2021

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

Control Number 02-CC-20210104140002

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: CUSTODIO-NOMELLINI, CARMEN	FACILITY NUMBER: 073404524
	VISIT DATE: 02/22/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

CONTINUED FROM PREVIOUS PAGE 9099

Based on the interviews and information obtained throughout the investigation, the allegation is UNSUBSTANTIATED at this time. 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 at this time.

No Deficiencies have been cited for the allegation. Exit interview conducted with Licensee where this report was discussed. A copy of the report is to be sent to obtain her signatures. Report to be returned to CCL by end of 02/23/21.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 725-5998
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2