283008881-2-1-2023-01-CC-LLEI-CNUW57-20230208155838

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 283008881
Report Date: 02/01/2023
Date Signed: 02/01/2023 10:47:09 AM

Unsubstantiated

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
10/04/2022 and conducted by Evaluator Melchisedeck Augustin

PUBLIC

COMPLAINT CONTROL NUMBER: 01-CC-20221004093303

FACILITY NAME:	WISNIEWSKI, JACQUELINE FCCH		FACILITY NUMBER:	283008881
ADMINISTRATOR:	WISNIEWSKI, JACQUELINE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 306-2491
CITY:	NAPA	STATE: CA	ZIP CODE:	94558
CAPACITY:	14	CENSUS: 7	DATE:	02/01/2023
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Jacqueline Wisniewski - Licensee		TIME COMPLETED:	09:40 AM

ALLEGATION(S):

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Day care child sustained unexplained injuries while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Melchisedeck Augustin made a subsequent complaint-investigation visit and met with Licensee, Jacqueline Wisniewski (LS) for the purpose of delivering finding for the above allegation. LPA previously met with LS on 10/12/22 to initiate the investigation by discussing the purpose of the visit, conducting interviews with LS and staff, making observations; and requesting a facility roster of the children currently in care. It was alleged that a day care child sustained unexplained injuries while in care. The report respectively noted the child (C1) had a visible red mark on left eye, welts on the back upper left arm.

LPA, Augustin interviewed LS and one staff (S1), two children (C2 & C3), six adults (A1-A6), and four parents (P1-P4), from 10/12/22 through 01/12/23. Some children were not verbal, too young to interview, or did not qualify to be interviewed. (Continue to LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023

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-20221004093303

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: WISNIEWSKI, JACQUELINE FCCH	FACILITY NUMBER: 283008881
	VISIT DATE: 02/01/2023

NARRATIVE

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According to LS’s statement, at the time C1 was dropped off at care, C1 experienced separation anxiety, C1 continued to cry and began to scratch which resulted in LS sending C1 to the cubby to sit down until C1 calmed down. LS claimed she was busy, but she periodically checked on C1 to ensure the child was okay. While sitting at the cubby, C1 had episodes such as throwing, dropping, and sliding off the cubby in which LS felt C1 sustained bruises from those episodes. Furthermore, LS expressed staff never hit any child in care and LS never had any concerns about how her staff interacted with the children in care.

The statements provided by the children and staff did not report any concerns at the facility or provide any information related to C1’s injuries. A statement confirmed when children got in trouble, they had to sit down in the cubby. S1 reported she was present on the day C1 was in care when C1 had a tantrum while sitting at the cubby and then throwing him/herself against the cubby and down on the floor resulting in C1 sustaining bruises. S1 claimed staff did not hit or handle C1 in a rough manner and C1 did not fall off any furnishing or play structure. Statements from A1 and A2 reported they witnessed LS handled child(ren) in what they perceived was an inappropriate or strict manner when they observed LS grabbed or pulled a child by the arm and hand to direct them to a room or place where she wanted the child to go. Based on overall statements provided, it could not be determined exactly when or how C1 sustained the visible bruises.

Based on LPA’s investigation, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the allegation occurred, therefore the above allegation is found to be UNSUBSTANTIATED. Exit interview conducted, and report was reviewed with the licensee, Jacqueline Wisniewski. Appeal rights were provided. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

**This report is amended**

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023

LIC9099 (FAS) - (06/04)

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