483005218-1-27-2022-01-CC-LLEI-CBX3AE-20220223170438

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 483005218
Report Date: 01/27/2022
Date Signed: 01/27/2022 01:06:40 PM

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
01/21/2022 and conducted by Evaluator Elpidia Hernandez Torres

COMPLAINT CONTROL NUMBER: 01-CC-20220121110100

FACILITY NAME:	GARY, MARIE FAMILY CHILD CARE HOME		FACILITY NUMBER:	483005218
ADMINISTRATOR:	GARY, MARIE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 208-1381
CITY:	SUISUN	STATE: CA	ZIP CODE:	94585
CAPACITY:	14	CENSUS: 10	DATE:	01/27/2022
		UNANNOUNCED	TIME BEGAN:	09:11 AM
MET WITH:	Licensee Marie Gary		TIME COMPLETED:	01:06 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Licensee is not using proper sleeping methods for day care child

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Elpidia Hernandez Torres arrived unannounced to conduct a complaint investigation. It is alleged Licensee is not using proper sleeping methods for day care child. Specifically, licensee is using a bean bag with a blanket laid on top for an infant to sleep on.

During the course of investigation, LPA interviewed two parents on 01/26/2022 at 03:05 PM, and 03:36 PM. According to interviews licensee placed C1 on top of a bean bag which had a blanket laid over the top. Interviews also revealed, licensee would lay C1 on the bean bag to fall asleep then transfer C1 to a play yard to sleep. Interviews revealed this occurred on at least two different occasions on 01/18 /2022 and 01/19/ 2022. Evidence was provided showing this method of sleep used at the facility.

LPA requested facility roster ( LIC 9040), and observed 10 children being supervised by licensee and assistant. All children were two years and older. LPA Interviewed Licensee on 01/27/2022 at 09:50AM. Licensee stated the current sleeping methods she uses for children two years and older are to place them on cots for nap time, but previously used a bean bag to place infant on to feel cuddled to fall asleep. . . Continuied on 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres	TELEPHONE: (707) 771-5568
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2022

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 3

Control Number 01-CC-20220121110100

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: GARY, MARIE FAMILY CHILD CARE HOME	FACILITY NUMBER: 483005218
	VISIT DATE: 01/27/2022

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

. . . As such, Licensee confirmed the sleeping methods as described above. Licensee also stated she no longer has infants in care and currently provides care for children aged two- four years old.

Based on evidence received, parent interviews, and Licensee’s admission to using the sleeping methods indicated above the preponderance of evidence standard has been met and the above allegation is found to be substantiated. The California Code of Regulations, Title 22, Division 12 & Chapter 1, section 102425(a) is being cited on attached LIC 9099D . This report was reviewed with the Licensee and an exit interview was conducted. Licensee’s signature was recorded on this Complaint Investigation Report (CIR), and a copy was provided.

Notice of Site Visit shall be posted for 30 days. Appeal Rights were provided. Type A violations are to be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres	TELEPHONE: (707) 771-5568
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 01-CC-20220121110100

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: GARY, MARIE FAMILY CHILD CARE HOME	FACILITY NUMBER: 483005218
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/27/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/28/2022 Section Cited CCR 102425(a)	1 2 3 4 5 6 7	(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. This has not been met as evidence by. . . .	1 2 3 4 5 6 7	Licensee stated bean bags will be used per the manufature age recommendations and currenlty had no infants in are. Licensee also agreed to complete a safe sleep traning and submit certificate with LIC 9098. https://cribsforkids.teachable.com/p/safe-sleep-ambassador/
	8 9 10 11 12 13 14	Based on interview and document review, licensee was using a bean bag to place child in to fall asleep on, then transferring into pack in play. This poses an immediate health and safety rick to children in care.	8 9 10 11 12 13 14	LIcensee will submit certificate with LIC 9098 to LPA Hernandez Torres by 01/31/2022 via email, mail or fax. elpidia.hernandez-torres@dss.ca.gov 1450 Neotomas Avenue Ste 100 Santa Rosa CA 95405 707-588-5099 Fax
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres	TELEPHONE: (707) 771-5568
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 3