125407882-9-10-2021-13-CC-EVIA-C69PP8-20210826112904

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 125407882
Report Date: 08/16/2021
Date Signed: 09/10/2021 01:48:27 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/05/2021 and conducted by Evaluator Kiriko Lynch

PUBLIC

COMPLAINT CONTROL NUMBER: 13-CC-20210805163954

FACILITY NAME:	JOHNSON, BELINDA FAMILY CHILD CARE HOME		FACILITY NUMBER:	125407882
ADMINISTRATOR:	JOHNSON, BELINDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 502-1116
CITY:	EUREKA	STATE: CA	ZIP CODE:	95503
CAPACITY:	14	CENSUS: 11	DATE:	08/16/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Belinda Johnson		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Licensee is not following COVID-19 guidance regarding facial coverings

INVESTIGATION FINDINGS:

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On 08/16/2021, Licensing Program Analyst (LPA) Kiriko Lynch conducted an initial 10-day complaint investigation and met with the Licensee. It was alleged Licensee is not following COVID-19 guidance regarding facial coverings, specifically that the licensee does not wear a facial covering while caring for children. The Licensee was interviewed on 08/16/21 at approximately 1:00 PM during the initial visit. She stated she follows all current COVID-19 guidance and mitigation, and has been teaching children mask/facial covering education and encouragement and had asked all parents/guardians if they were okay with her not wearing a mask, but didn’t realize that it was still a staff requirement. Upon arriving to the facility during the initial visit, LPA observed that the Licensee was not wearing a facial covering, but put one on when LPA informed her of the current guidance. Based on the evidence obtained, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. LPA issued an advisory note (see LIC 9102 Technical Assistance). This report was reviewed and discussed with Licensee. Appeal rights were provided and exit interview conducted. All licensing reports are public information and must be made available upon request for at least three years. The Notice of Site Visit must be posted for 30 days.

Substantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Kiriko Lynch	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021

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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