483003223-6-12-2019-01-CC-LLEI-BDKW22-20190628165334

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 483003223
Report Date: 06/12/2019
Date Signed: 06/12/2019 11:57:11 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/11/2019 and conducted by Evaluator Melchisedeck Augustin

PUBLIC

COMPLAINT CONTROL NUMBER: 01-CC-20190411091554

FACILITY NAME:	PETERSEN-LAWSON, SHELETTA FAMILY CHILD CARE HOME		FACILITY NUMBER:	483003223
ADMINISTRATOR:	PETERSEN-LAWSON, SHELETTA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 553-9809
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94589
CAPACITY:	14	CENSUS: 10	DATE:	06/12/2019
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Sheletta Petersen-Lawson		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Licensee failed to meet the children’s needs in care.

INVESTIGATION FINDINGS:

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A subsequent complaint investigation was conducted at the facility by Licensing Program Analyst (LPA) Melchisedeck Augustin. It is alleged the Licensee failed to meet the children's needs in care. The allegation specifies that a child (C1) pooped on herself, the Licensee failed to wipe C1 down; and another child (C2) was crying for 45 minutes and the Licensee failed to assist C2.

LPA previously met with Licensee Sheletta Petersen-Lawson on 04/17/19 and LPA Augustin discussed the allegation with the Licensee. LPA qualified and interviewed three children (C1, C3-C4) on 04/17/19 at 2:42pm, interviewed two staff (S1-S2) on 04/17/19 at 1:35pm, and interviewed Licensee on 04/17/19 at 2:55pm; and obtain a facility roster of the children in care. LPA conducted subsequent interviews with one adult (A1) and one parent (P2) on 05/28/19 at 1:26pm and interviewed one parent (P3) and one adult on 06/07/19. On 06/12/19 at 9:22am, LPA conducted interviews with two parents (P4-P5). LPA made several attempts to interview P1, however P1 did not respond. LPA Augustin conducted two separate inspections on 04/17/19 and 06/12/19, and during both inspections, LPA observed staff changing children’s diapers, feeding the children, staff conducting indoor curriculum for the children; and staff tending to the children’s needs.

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: 06/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2019

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-20190411091554

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: PETERSEN-LAWSON, SHELETTA FAMILY CHILD CARE HOME	FACILITY NUMBER: 483003223
	VISIT DATE: 06/12/2019

NARRATIVE

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An interview with C3-C4, S1-S2, A1 and A2 did not corroborate the allegation that the Licensee failed to meet the children’s need and C2 was crying for 45 minutes; and the Licensee failed to assist C2. There is insufficient information available for LPA to determine if Licensee failed to meet C1’s needs and there is insufficient information available to establish the identity of C2. An interview with P3, P4-P5 revealed that parents are satisfied with how staff respond to the children’s needs and the level of care that staff provide for the children. On 04/17/19 at 2:55pm, the Licensee claimed she has never failed to meet any child's needs and she promptly tends to children needs. There is insufficient evidence to determine if the allegation did or did not occur, and the allegation is unsubstantiated.

This report was reviewed and discussed with the Licensee. Notice of Site Visit shall be posted for 30 days from today’s inspection. There were no Title 22 deficiency cited during today’s inspection. Appeal Rights were provided.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2019

LIC9099 (FAS) - (06/04)

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