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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 483007757
Report Date: 11/08/2021
Date Signed: 11/17/2021 11:25:16 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/23/2021 and conducted by Evaluator Mary Trinh
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20210823113251
FACILITY NAME:CIRCLE OF FRIENDS CHILD DEVELOPMENT CENTER - P/SFACILITY NUMBER:
483007757
ADMINISTRATOR:THOMAS, ROSELLA E.FACILITY TYPE:
850
ADDRESS:3330 DOVER AVENUETELEPHONE:
(707) 425-2717
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:88CENSUS: 40DATE:
11/08/2021
UNANNOUNCEDTIME BEGAN:
02:07 PM
MET WITH:Rose ThomasTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff hit child
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mary Trinh met with Rose Thomas, Director (D1) to deliver complaint findings. It was alleged that staff hit Child 1 (C1) on 08/20/2021. On 08/30/2021 LPA Trinh interviewed Staff 1 (S1) at 2:25 pm, and Director 1 (D1) at 2:35 pm. D1 stated that Staff 2 (S2) who allegedly hit C1 was terminated on 08/20/2021 after an internal investigation of the incident. S1 witnessed S2 hitting C1 on the leg.
Based on the information gathered during this investigation, there is a preponderance of evidence to prove that staff hit child on 08/20/2021. The allegation is determined to be Substantiated.
Appeal rights printed and given to D1.
Notice of site visit given to D1.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Mary Trinh
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021
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 2
Control Number 01-CC-20210823113251
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: CIRCLE OF FRIENDS CHILD DEVELOPMENT CENTER - P/S
FACILITY NUMBER: 483007757
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/08/2021
Section Cited
HSC
101223
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101223 Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights:
(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.
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Train newly hired staff on what Personal Rights are. Also, to have annual training for current staff on Personal Rights. POC to be completed by 11/09/2021.
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The above regulation was not met as evidenced by, Staff (S2) hit child on the leg and this was witnessed by Staff (S1) on 08/20/2021.
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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.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Mary Trinh
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021
LIC9099 (FAS) - (06/04)
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