483007592-12-12-2024-01-CC-LLEI-DBZVRZ-20241216154042

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 483007592
Report Date: 12/12/2024
Date Signed: 12/12/2024 02:14:32 PM

Substantiated

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
09/25/2024 and conducted by Evaluator Melchisedeck Augustin

PUBLIC

COMPLAINT CONTROL NUMBER: 01-CC-20240925150435

FACILITY NAME:	VAEZINIA, VICTORIA FAMILY CHILD CARE HOME		FACILITY NUMBER:	483007592
ADMINISTRATOR:	VAEZINIA, VICTORIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 452-8888
CITY:	VACAVILLE	STATE: CA	ZIP CODE:	95687
CAPACITY:	14	CENSUS: 8	DATE:	12/12/2024
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Victoria Vaezinia - Licensee		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Licensee is operating over capacity

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Melchisedeck Augustin made an unannounced Complaint-Investigation visit and met with Licensee (LS), Victoria Vaezinia, for the purpose of delivering finding for the above allegation. LPA previously met with the Facility Representative (FR) on 09/27/24 to initiate the investigation by discussing the purpose of the visit, conducted an interview with FR and staff; and requested a facility roster of the children in care. It is alleged that the Licensee is operating over capacity.

LPA interviewed LS and two staff (FR & S1), two adults (A1-A2), and eight parents (P1-P8), starting on 09/27/24 through 12/10/24. LS denied the facility operated over capacity, and according to LS, in June/July 2024, she complied with the terms of the license by operating with only up to 14 children. LS said the children arrived/left at various times of the day which LS confirmed she did not track or have evidence to prove, and parents never dropped their child(ren) off without LS authorizing it ahead of time. (Continue to LIC 809-D)

Substantiated

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: 12/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024

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-20240925150435

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: VAEZINIA, VICTORIA FAMILY CHILD CARE HOME	FACILITY NUMBER: 483007592
	VISIT DATE: 12/12/2024

NARRATIVE

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LS explained she submitted the attendance sheets to the subsidy program, she never signed the forms under false pretense, and LS claimed parents signed & printed the hours on their child’s Attendance sheet to confirm the days and hours their child attended care; proceeded by LS signing forms for each child to validate care was provided. LS acknowledged after she signed, and prior to submitting the forms to the subsidy program, she did not review the information the parents reported. FR and S1 reported they did not know how many children were present on each of those days, but the facility had a different number of children each day. FR expressed the facility did not kick out the children, and FR & S1 confirmed that only LS completed the Attendance sheets, and S1’s statement corroborated the allegation when she reported the facility operated with 14 children daily, but some days, it was plus or minus one child, which exceeded the terms of the license.

P1-P8 confirmed they were registered with the subsidy program, and they completed their child(ren)’s Attendance sheets for the month of June/July 2024, and their children attended care as documented on the Attendance sheet. Parents’ statements were consistent with each other, confirming at least 14 children were in care during the dates notated above. On 09/27/24, the department received evidence from a credible source which contradicted LS’s claims about operating within the terms of the license. The evidence showed there were as many as 15 children in care on the dates notated above. Additionally, the evidence further indicated LS signed a form for each child to certify the hours were true and correct; LS declared she provided childcare services for up to 15 children from period, 07/15/24 through 07/19/24. Based on this investigation, there is preponderance of evidence to show LS provided care for the number of children as she declared, and the allegation is substantiated.

Exit interview conducted and report was reviewed with the licensee, Victoria Vaezinia. A notice of site visit was given to licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. The following violation(s) of the California Code of Regulations, Title 22; Division 12, was cited during today’s visit. See LIC attached LIC 809-D. 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: 12/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024

LIC9099 (FAS) - (06/04)

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Control Number 01-CC-20240925150435

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: VAEZINIA, VICTORIA FAMILY CHILD CARE HOME	FACILITY NUMBER: 483007592
	VISIT DATE: 12/12/2024

NARRATIVE

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LPA, Melchisedeck Augustin informed licensee that this report dated 12/12/2024 document(s) one Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA Melchisedeck Augustin informed the licensee to provide a copy of this licensing report dated 12/12/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 01-CC-20240925150435

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: VAEZINIA, VICTORIA FAMILY CHILD CARE HOME	FACILITY NUMBER: 483007592
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/12/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 12/13/2024 Section Cited CCR 102416.5(a)	1 2 3 4 5 6 7	The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. This requirement is not met as evidenced by: Based on the department receiving credible evidence which showed there were as many as 15 children in care. The licensee did not	1 2 3 4 5 6 7	Licensee stated she would produce a written statement detailing the positive steps she implemented to ensure accuracy of Attendance sheets and compliance with staff ratio and capacity requirements. Licensee agreed to submit her Plan of Correction (POC) to the department by 12/13/24 via email or fax.
	8 9 10 11 12 13 14	comply with the section cited which poses/posed an immediatel health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14	Email: melchisedeck.augustin@dss.ca.gov Fax: 707-588-5099
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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.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024

LIC9099 (FAS) - (06/04)

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