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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 233009419
Report Date: 12/16/2019
Date Signed: 12/17/2019 09:27:35 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
12/11/2019 and conducted by Evaluator Mary Trinh
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20191211134533
FACILITY NAME:PITTMAN, JENNIFER FCCHFACILITY NUMBER:
233009419
ADMINISTRATOR:PITTMAN, JENNIFERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 391-3403
CITY:UKIAHSTATE: CAZIP CODE:
95482
CAPACITY:14CENSUS: 8DATE:
12/16/2019
UNANNOUNCEDTIME BEGAN:
12:02 PM
MET WITH:Jennifer Pittman, LicenseeTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Day care child was bit by dog sustaining injuries.
INVESTIGATION FINDINGS:
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A complaint investigation inspection was made to the facility by Licensing Program Analyst (LPA), Mary Trinh. It has been alleged that Child 1 (C1) was bit by dog sustaining injuries. LPA Trinh met with and interviewed the Licensee on 12/16/2019 at 12:30 pm and discussed the allegation. The Licensee stated that on 12/09/2019 C1 was hugging her dog around the neck and that is when the dog bit C1. During today’s inspection LPA Trinh observed that Licensee's dog was kept in a locked bedroom and away from children in care. LPA Trinh obtained a current roster of children in care. Licensee reported the Unusual Incident Report (UIR) to LPA Trinh on 12/10/2019. The wriiten UIR will be sent to LPA Trinh after report from C1 Parent about Doctor's visit is completed.
Based on the information gathered during this investigation, there is a preponderance of evidence to prove that C1 was biten by Licensee's dog on 12/09/2019. The allegation is determined to be Substantiated.
Deficiency and Immediate Civil Penalty of $500 was issued. See LIC 9099 D.
This report was read and reviewed with Licensee.
Appeal rights were provided.
Notice of Site Visit must be posted for 30 days.





Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Mary TrinhTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2019
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 01-CC-20191211134533
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: PITTMAN, JENNIFER FCCH
FACILITY NUMBER: 233009419
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/16/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/16/2019
Section Cited
CCR
102423(a)(2)
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102423 Persoanl Rights
(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following:
(2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
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Licensee POC is to keep her dog seperate from children in care and to put a muzzle on the dog when transporting outside to go potty. POC is observed by LPA Trinh and corrected on this date of 12/16/2019.
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This requirement was not met as evidenced that on 12/09/2019 Licensee's dog bit C1 in the face area.
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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: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Mary TrinhTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 2