233007674-7-19-2021-01-CC-AHON-C5LS6U-20210805133630

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 233007674
Report Date: 07/14/2021
Date Signed: 07/19/2021 11:42:47 AM

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
06/21/2021 and conducted by Evaluator Mary Trinh

PUBLIC

COMPLAINT CONTROL NUMBER: 01-CC-20210621155219

FACILITY NAME:	JOHNSTON, DANNA FCCH		FACILITY NUMBER:	233007674
ADMINISTRATOR:	JOHNSTON , DANNA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 467-9149
CITY:	UKIAH	STATE: CA	ZIP CODE:	95482
CAPACITY:	14	CENSUS: 10	DATE:	07/14/2021
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Danna Johnston		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Licensee/staff do not wear a mask around daycare children.

INVESTIGATION FINDINGS:

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Licensing Program (LPA) Mary Trinh met with Danna Johnston, Licensee (L1) to deliver complaint findings. It was alleged that Licensee/Staff do not wear mask around daycare children. On 06/23/2021 LPA Trinh interviewed L1(at 1:30 pm), L2 (at 1:45 pm) and L3 (at 2:20 pm). LPA Trinh also interviewed Children 1,2, and 3 (C1 at 2:00 pm,
C2 at 2:10 pm, C3 at 2:15 pm). All Licensee/Staff and Children confirmed that he/she wears masks indoors and outdoors (if cannot be six feet or more apart). LPA Trinh observed all staff and children to be wearing masks on visit of 06/23/2021. On 07/08/2021 at 1:00 pm, LPA Trinh interviewed Adult 2 (A2) who confirmed that all Licensee/Staff and Children wears masks indoors and outdoors.
Continued...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Mary Trinh	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021

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-20210621155219

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: JOHNSTON, DANNA FCCH	FACILITY NUMBER: 233007674
	VISIT DATE: 07/14/2021

NARRATIVE

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This agency has investigated the complaint alleging that Licensee/Staff do not wear mask around daycare children. We have found that the complaint is 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.
Appeal rights printed and given to Licensee.
Notice of site visit printed and given to Licensee to post where parents can see.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Mary Trinh	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021

LIC9099 (FAS) - (06/04)

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