230110064-9-23-2021-01-CC-AHON-C79VGE-20210927162523

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 230110064
Report Date: 09/21/2021
Date Signed: 09/23/2021 04:00:19 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/19/2021 and conducted by Evaluator Mary Trinh

PUBLIC

COMPLAINT CONTROL NUMBER: 01-CC-20210819142126

FACILITY NAME:	SOUTH COAST DAY CARE		FACILITY NUMBER:	230110064
ADMINISTRATOR:	VAUGHAN, TERRI A.		FACILITY TYPE:	850
ADDRESS:	115 LAKE STREET		TELEPHONE:	(707) 882-2946
CITY:	POINT ARENA	STATE: CA	ZIP CODE:	95468
CAPACITY:	25	CENSUS: 13	DATE:	09/21/2021
		UNANNOUNCED	TIME BEGAN:	02:01 PM
MET WITH:	Terri Vaughan		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Child sustained injuries while in care.
Parent was not informed of child's injuries.
Children were not fed while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Trinh met with Terri Vaughan, Licensee (L1) to deliver complaint findings. It was alleged that Child sustained injuries while in care, Parent was not informed of child's injuries and Children were not fed while in care. On 08/23/2021 LPA Trinh interviewed L1 (at 2:35 pm), Staff 2 (at 2:45 pm) and Child 1, 2, and 3 (at 3:00 pm to 3:10 pm). It was alleged that Child 4 (C4) and Child (C5) attended day care for a few days in which they sustained physical injuries and that parent was never notified. L1 and Staff 2 states only (C4) had an incident on 08/17/2021. L1 and Staff 2 states that (C4) took off her shoes, ran to a round table and tripped on the leg of a chair. L1 and Staff 2 states parent of (C4) was notified and signed the "Accident Report" on 08/18/2021. It was alleged that staff did not provide (C4) and (C5) their packed lunch. L1 and Staff 2 states that C4 and C5 packed lunch were provided in addition to snacks.
Continued...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Mary Trinh
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021

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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Control Number 01-CC-20210819142126

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: SOUTH COAST DAY CARE	FACILITY NUMBER: 230110064
	VISIT DATE: 09/21/2021

NARRATIVE

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This agency has investigated the complaint alleging the noted complaints. We have found that the allegations are Unsubstantiated.
Based on the information gathered during this investigation, there is insufficient information to prove or disprove the allegations as reported. There is not a preponderance of the evidence to prove the allegations, therefore the findings are determined to be Unsubstantiated.
Advisory on Reporting Requirements 101212 was explained to L1. An Unusual Incident Report (UIR) should be telephone called into Community Care Licensing (CCL) within next working day and a written report (LIC 624) turned into (CCL) within seven business days.
(See LIC9102)
Appeal rights printed and given to Licensee.
Notice of site visit printed and given to Licensee to post where parents can see.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Mary Trinh
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021

LIC9099 (FAS) - (06/04)

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