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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 283008881
Report Date: 12/21/2023
Date Signed: 12/21/2023 03:02:00 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 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
11/09/2023 and conducted by Evaluator Melinda Mohr
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20231109144920
FACILITY NAME:WISNIEWSKI, JACQUELINE FCCHFACILITY NUMBER:
283008881
ADMINISTRATOR:WISNIEWSKI, JACQUELINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 306-2491
CITY:NAPASTATE: CAZIP CODE:
94558
CAPACITY:14CENSUS: DATE:
12/21/2023
UNANNOUNCEDTIME BEGAN:
01:31 PM
MET WITH:Jacqueline WisniewskiTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Licensee did not provide Type A citation report to parent upon enrollment
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mindy Mohr made an unannounced complaint investigation visit today, and met with Licensee, Jacqueline Wisniewski, for the purpose of delivering findings of the above allegation. LPA Mohr previously met with Jacqueline on 11/15/2023 to open the complaint. It was alleged that the Licensee did not provide the full licensing report dated 10/05/2022 to parent(s) when enrolling their child, which contained pertinent detailed information about the prior complaint investigation that resulted in a Type A citation.

During the course of the investigation, LPA Mohr conducted interviews and received documents pertaining to the investigation. From 11/15/2023 through 12/08/2023, interviews were conducted with Licensee (L1) and nine adults (A1-A9).
Licensee denied the claim about not providing parents with the licensing report. L1 stated that she is losing enrollment due to her Type A violation and claimed she was not aware she was required to give families the report or the LIC9224 upon enrollment of a new child.
Continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melinda Mohr
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023
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-20231109144920
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: WISNIEWSKI, JACQUELINE FCCH
FACILITY NUMBER: 283008881
VISIT DATE: 12/21/2023
NARRATIVE
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A1, A3, A5 and A6 all confirmed they did not receive the 10/05/2022 licensing report with the Type A citation at the time of enrollment, stating that they were verbally informed about the Type A violation either after their child’s enrollment or after their children started at the day care. A2 and A9 stated they were never informed of or given a form to sign regarding the Type A violation. A4 stated that their child was enrolled in the daycare at the time of the complaint, and they were verbally told about the complaint but were never given the physical report. A7 and A8 stated they were verbally told about the Type A violation, but do not remember if they were given the report. Furthermore, A1, A3, A4, and A5 stated the Licensee downplayed the seriousness of the incident and/or blamed others. A1 also stated if they knew of the report, they would not have enrolled their child.

On 11/15/2023 LPA Mohr reviewed currently enrolled children’s files which showed all children files contained a signed LIC9224, but statements confirm L1 did not provide the licensing report to parents when enrolling their children resulting in the non-compliance of Health and Safety Code 1596.8595(c)(2).

Based on the investigation, the preponderance of evidence standard has been met. Therefore, the above allegations are found to be substantiated. The following violation of the Health and Safety Code is being issued: see LIC 9099D.

Exit interview was conducted, and report reviewed with Licensee Jacqueline Wisniewski.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melinda Mohr
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 01-CC-20231109144920
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: WISNIEWSKI, JACQUELINE FCCH
FACILITY NUMBER: 283008881
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/21/2023
Section Cited
HSC
1596.8595(c)(2)
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Upon enrollment of a new child in a facility, the licensee shall provide to the parents or legal guardians of the newly enrolling child copies of any licensing report that the licensee has received during the prior 12-month period that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as set forth in paragraph (1) of subdivision (a) of Section 1596.893b.
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Licensee stated she would produce a written plan detailing how she would ensure that she will provide parents or legal quardians of newly enrolled children a full physical copy of the licensing reports which cite a type A violation.
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This requirement is not met as evidenced by: Based on statements which confirm L1 did not provide the full written report to all parents upon enrollement. This posed a potential health, safety and/or personal rights risk to the children in care.
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Licensee will submit her written plan to LPA Mohr via mail, fax or email : melinda.mohr@dss.ca.gov
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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.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melinda Mohr
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023
LIC9099 (FAS) - (06/04)
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