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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 173008720
Report Date: 09/08/2022
Date Signed: 09/08/2022 01:06:01 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/16/2022 and conducted by Evaluator Sebastian Phouthavong
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20220616142111
FACILITY NAME:MCBRAYER, MICHELLE FCCHFACILITY NUMBER:
173008720
ADMINISTRATOR:MCBRAYER, MICHELLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 994-9580
CITY:CLEARLAKESTATE: CAZIP CODE:
95422
CAPACITY:14CENSUS: 1DATE:
09/08/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Michelle McbrayerTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Facility failed to follow Safe Sleep requirements.

Facility staff handled children roughly.
INVESTIGATION FINDINGS:
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An unannounced follow-up complaint investigation visit to the facility was made today by Licensing Program Analysts (LPAs), Y. Yang and S. Phouthavong to deliver complaint investigation findings. It has been alleged that facility staff handled children roughly; specifically, it was alleged that a staff member pulled a daycare child’s ear. It was also alleged that the facility failed to follow infant safe sleep regulations by not ensuring a safe sleep environment and/or documenting infant naps as required.

The LPAs met with the facility’s licensee, Michelle McBrayer (L1) today to discuss the investigation findings. The facility was toured inside and out. There was one infant receiving care today. The licensee was not present at the facility during the initial investigation on 06/16/22. The LPAs interviewed the licensee’s assistant, staff S1 and S2 regarding the allegation.

Continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Sebastian PhouthavongTELEPHONE: 707-588-5056
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
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 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/16/2022 and conducted by Evaluator Sebastian Phouthavong
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20220616142111

FACILITY NAME:MCBRAYER, MICHELLE FCCHFACILITY NUMBER:
173008720
ADMINISTRATOR:MCBRAYER, MICHELLEFACILITY TYPE:
810
ADDRESS:13731 LAKESHORETELEPHONE:
(707) 994-9580
CITY:CLEARLAKESTATE: CAZIP CODE:
95422
CAPACITY:14CENSUS: 1DATE:
09/08/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Michelle McbrayerTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Facility failed to stay within ratio and/or capacity requirements.
INVESTIGATION FINDINGS:
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An unannounced follow-up complaint investigation visit to the facility was made today by Licensing Program Analysts (LPAs), Y. Yang and S. Phouthavong to deliver complaint investigation findings. It has been alleged facility failed to stay within ratio and/or capacity requirements. Specifically, it was alleged that the facility is providing care and supervision for more than fourteen children at one time or providing care and supervision to more than eight children without an assistant being present.

Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Sebastian PhouthavongTELEPHONE: 707-588-5056
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
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 6
Control Number 01-CC-20220616142111
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: MCBRAYER, MICHELLE FCCH
FACILITY NUMBER: 173008720
VISIT DATE: 09/08/2022
NARRATIVE
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The LPAs met with the facility’s licensee, Michelle McBrayer (L1) today to discuss the investigation findings. The facility was toured inside and out. There was one child present at the facility today being supervised by two staff members. The initial investigation visit was made by the LPAs on 06/16/22. There were 7 children, and 2 staff members present during this visit. A second investigation visit was made by LPA S. Phouthavong on 07/22/22. There were 14 children, and 2 staff present during the visit. The facility was operating within ratio and capacity during both inspection visits, although the Licensee was not present at either inspection.

During the initial investigation visit made by the LPAs on 06/16/22. The licensee was not present at the facility at the time of the visit. The LPAs interviewed the licensee’s assistant, staff S1 and S2 regarding the allegation. Both staff members denied the allegations. The licensee was interviewed on 08/01/2022. The licensee denied the allegation and stated that all capacity and ratio regulations are being followed by the facility.

During the investigation, interviews were conducted with the childcare facility’s clients, L1 and current staff members S1-S2 on 06/16/22, 06/21/22, 07/25/22, 07/28/22 and 08/01/22. Current staff members that were interviewed all corroborated the licensee’s statements. All parents and children interviewed all stated that they have not observed the licensee providing care and supervision for more than fourteen children or operating over ratio. One client who was interviewed stated that the Licensee will leave 1 staff with 11-14 children while the Licensee is out of the facility, although this was not corroborated.

Based on the information gathered during this investigation, there is not a preponderance of evidence to support the allegation. The allegation is determined to be unsubstantiated. There were no Title 22 deficiencies cited. This report was reviewed and discussed with the facility’s licensee, Michelle McBrayer. Appeal rights were provided. Notice of Site Visit shall be posted for 30 days from today's visit.

SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Sebastian PhouthavongTELEPHONE: 707-588-5056
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 01-CC-20220616142111
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: MCBRAYER, MICHELLE FCCH
FACILITY NUMBER: 173008720
VISIT DATE: 09/08/2022
NARRATIVE
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Both staff member’s stated that they are providing a safe sleep environment for infants but were not documenting an infant’s naps every 15 minutes as they did not know this was a requirement. During the LPA’s initial visit on 06/16/22, the LPA’s observed that there were no infants present at the facility. The LPA’s inspected the infant sleep area and observed that there was a stack of blankets folded and placed in the crib. Staff S1 and S2 stated that the blankets and other prohibited items are removed when an infant is present. During this investigation visit, the LPA’s reviewed the infant safe sleep regulations with the staff members present. The licensee stated on 08/01/2022 that one infant was currently enrolled at the facility. The licensee stated that the facility is practicing safe sleep practices by not allowing the children to nap with pillows, blankets and other objects. The licensee stated that the facility was not documenting the 15 minutes nap checks, however but has since started documenting 15 minutes naps checks.

During an interview with staff S1 on 06/16/22, S1 admitted that she pulled a child’s ear on an unspecified date to get the child’s attention. S1 stated that this was the only incident where a child was roughly handled at the facility. The licensee was interviewed on 08/01/2022 and stated that she was aware of this incident. This incident was not reported to Community Care Licensing.

During the investigation, interviews were conducted with the childcare facility’s clients, children, L1 and current staff members S1-S2 on 06/16/22, 06/21/22, 07/25/22, 07/28/22 and 08/01/22. The children that were interviewed all stated that they did not have any concerns about the licensee or any other staff member and enjoy attending this daycare facility. The children that were interviewed all stated that they felt safe at the daycare. Clients that were interviewed all stated that they have not observed any staff member rough handling a child in care and did not have any concerns about the facility or a staff member.

Based on available information and the licensee’s and staff S1’s own admission, the preponderance of evidence standard has been met; therefore, the allegations are found to be substantiated. California Code of Regulations, Title 22, is being cited on the attached LIC 9099-D. An exit interview was conducted, and this report was read and discussed with the facility’s licensee, Michelle McBrayer. Appeal rights were provided. The Notice of Site Visit shall be posted for 30 days.

Reports citing Type A violations are to be provided to parents/guardians of children currently enrolled by the next business day or the next day the children are in care, and to parents/guardians of children newly enrolled at the facility for the next 12 months from the date of this report. Parents/guardians must sign Form LIC 9224 to be kept in each child's file.

SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Sebastian PhouthavongTELEPHONE: 707-588-5056
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 01-CC-20220616142111
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: MCBRAYER, MICHELLE FCCH
FACILITY NUMBER: 173008720
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/15/2022
Section Cited
CCR
102425(j)(1)
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The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
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This deficiency has been cleared today during this visit. The licensee furnished proof to the LPAs that 15 minutes checks were being conducted and documented for infants at the facility.
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Based on interviews with staff, S1 and S2 on 06/21/2022 and L1 on 08/01/2022, the facility could not furnishing proof that 15 minutes checks had were being conducted and documented for infants. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
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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.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Sebastian PhouthavongTELEPHONE: 707-588-5056
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 01-CC-20220616142111
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: MCBRAYER, MICHELLE FCCH
FACILITY NUMBER: 173008720
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/09/2022
Section Cited
CCR
102423(a)(4)
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a)Each child receiving services from a family child care home shall have certain rights that shall not be waived...not limited to, the following:(4)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...
This requirement was not met as evidenced by:
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Licensee and staff will sign a statement that they have read and understood the Personal Rights Title 22 Regulations and will submit documentation to the LPA that this has been completed by 09/09/22.

sebastian.phouthavong@dss.ca.gov
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Based on interviews with L1 and S1 on 06/22/22 and 08/01/22, it was corroborated that on an unspecified date, S1 grabbed child C1 by their ear to get child 1 C1's attention, which poses an immediate Health, Safety or Personal Rights risk to children in care.
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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.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Sebastian PhouthavongTELEPHONE: 707-588-5056
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 6