283009308-10-31-2022-01-CC-LLEI-CKUMD4-20221104093027

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 283009308
Report Date: 10/31/2022
Date Signed: 10/31/2022 10:36:42 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
07/25/2022 and conducted by Evaluator Kevin O'Connell

COMPLAINT CONTROL NUMBER: 01-CC-20220725103519

FACILITY NAME:	MONERO, KIMBERLEE FCCH		FACILITY NUMBER:	283009308
ADMINISTRATOR:	MONERO, KIMBERLEE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 416-3316
CITY:	AMERICAN CANYON	STATE: CA	ZIP CODE:	94503
CAPACITY:	14	CENSUS: 5	DATE:	10/31/2022
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Kim Monero, Licensee		TIME COMPLETED:	10:50 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not report injury to authorized representative.
Licensee does not keep the facility free from pests.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst, Kevin O’Connell made a subsequent complaint investigation on 10/31/2022 at 09:35am and met with the Facility Representative, Kimberlee Monero (L), to deliver the findings regarding the above allegations.
LPA O’Connell previously met with L on 8/01/2022 to initiate the investigation by discussing the purpose of the visit, conducting interviews, obtaining facility roster, reviewing documents, and making observations.
L denied the allegations at 10:05am on 8/01/22, stating that all injuries are reported to the parents and by the latest by the end of the day, I have never had pest problems in the home and had a pest control company spray monthly for years and have given the dogs flea medication routinely for many years.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'Connell	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2022

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 4

Control Number 01-CC-20220725103519

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: MONERO, KIMBERLEE FCCH	FACILITY NUMBER: 283009308
	VISIT DATE: 10/31/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Investigation consisted of one staff member (S1) interviewed on 8/1/22, six Parents (P1- P6) interviewed from 10/24 /22 to 10/27/22, Licensee (L) interviewed on 8/1/22 & 10/24/22, observations made 8/1/22 and document review.

Adult statement ( A1) reported that her child came home from the facility with an unexplained injury and on different occasions came home with what appeared to be flea bites on the legs but no other individuals were able to confirm this. Parents interviewed (P1- P6) had no issues with reporting of injuries timely or any pest problems or flea bites on their children and thus could not corroborate the allegations. L stated that she did cancel the pest control monthly service in early July.

Based on the information gathered during this investigation, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the allegations occurred and therefore are determined to be unsubstantiated. There were no Title 22 deficiencies cited on the above allegations. This report was reviewed and discussed with the Facility Representative, Kimberlee Monero. Appeal Rights were provided.
Notice of Site Visit shall be posted for 30 days from today's visit.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'Connell	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 4