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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 280108344
Report Date: 10/30/2023
Date Signed: 11/12/2023 07:15:15 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
08/16/2023 and conducted by Evaluator Leticia Rosales
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20230816150544
FACILITY NAME:CANV KIDS DEVELOPMENT & FAMILY PROGRAM AKA LOS NINFACILITY NUMBER:
280108344
ADMINISTRATOR:KATHY PEEBLESFACILITY TYPE:
850
ADDRESS:1510 MYRTLE AVENUETELEPHONE:
(707) 253-6173
CITY:NAPASTATE: CAZIP CODE:
94558
CAPACITY:60CENSUS: 28DATE:
10/30/2023
UNANNOUNCEDTIME BEGAN:
02:45 AM
MET WITH:Evelyn Fuentes, Site SupervisorTIME COMPLETED:
05:10 PM
ALLEGATION(S):
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Staff spoke inappropriately to child in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Leticia Rosales-Meza made a subsequent complaint investigation inspection, for the purpose of delivering complaint findings, and met with the Site Supervisor, Evelyn Fuentes. It has been alleged that staff spoke inappropriately to child in care, specifically that a teacher yelled at Child 1 (C1) to shut up" and "stop crying".

During the initial complaint investigation to the facility on 8/24/23, records were reviewed, and interviews were conducted with six staff (S1-S6) and three children (C2-C) starting at 12:40 PM. An interview was conducted with the Site Supervisor, (SS) Evelyn Fuentes at 12:20 PM. Interviews with staff corroborated that on one occasion they heard Staff 7(S7) speak inappropriately to C1, specifically that S7 yelled and said things in a mean way when frustrated and when C1 not wanting to nap. Interviews with staff corroborate that they heard S7 tell C1 in a loud voice to "be quiet" and "stop crying". SS stated that S7 is no longer employed at the facility.

Continue on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Leticia RosalesTELEPHONE: (707) 588-5061
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2023
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 3
Control Number 01-CC-20230816150544
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: CANV KIDS DEVELOPMENT & FAMILY PROGRAM AKA LOS NIN
FACILITY NUMBER: 280108344
VISIT DATE: 10/30/2023
NARRATIVE
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Another staff stated they heard S7 yell at C1 to "be quiet, you have to go to sleep". Some staff stated even though they were not in the same classroom where this incident occurred, staff could hear the loud voice of S7.

Based on information obtained, and records reviewed during the investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be Substantiated. California Code of Regulations, Title 22 is being cited on the attached LIC 9099-D. Appeal rights were provided.

LPA Leticia Rosales-Meza informed facility representative, Evelyn Fuentes that this report dated 11/06/23 documents one Type A citation. Type A citations shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.



Also, LPA Rosales-Meza informed the facility representative to provide a copy of this licensing report dated 11/06/2023 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted, and report was reviewed with the Site Supervisor, Evelyn Fuentes.

A notice of site visit was given and must remain posted for 30 days from today's date. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Leticia RosalesTELEPHONE: (707) 588-5061
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 01-CC-20230816150544
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: CANV KIDS DEVELOPMENT & FAMILY PROGRAM AKA LOS NIN
FACILITY NUMBER: 280108344
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/06/2023
Section Cited
CCR
101223(a)(1)
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Personal Rights: The licensee shall ensure that each child is accorded the following personal rights: (1) To be accorded dignity in his/her personal relationships with staff and other persons.

This requirement is not met as evidenced by:
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SS stated after speaking with the Program Director and Staff 7 (S7), it was decided that S7's employment was terminated on 08/17/23. SS stated immediately after of the occurrence, we had a training with all the staff on "what to do" on situation where staff
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Based on interviews, a staff (S7) yelled and spoke inappropriately to C1, when not wanting to nap. This poses an immediate health and safety or personal rights risk to the children in care.
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might feel overwhelmed, and needing to step out of the classroom when not having control of the situation, and a child not cooperating with the situation in process. SS will submit proof of the "staff training" that was conducted in August 2023 to LPA by 11/09/23.
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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: Leticia RosalesTELEPHONE: (707) 588-5061
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3