483008718-7-26-2021-01-CC-LLEI-C5B3NW-20210726182435

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 483008718
Report Date: 07/26/2021
Date Signed: 07/26/2021 09:42:22 AM

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
04/26/2021 and conducted by Evaluator Melchisedeck Augustin

PUBLIC

COMPLAINT CONTROL NUMBER: 01-CC-20210426140506

FACILITY NAME:	CLAVERIE, CLAUDIA FCCH		FACILITY NUMBER:	483008718
ADMINISTRATOR:	CLAVERIE, CLAUDIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 746-1392
CITY:	BENICIA	STATE: CA	ZIP CODE:	94510
CAPACITY:	14	CENSUS: 10	DATE:	07/26/2021
		UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Claudia Claverie		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Licensee inappropriately restrained a daycare child while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Melchisedeck Augustin conducted an unannounced subsequent complaint investigation visit and met with Licensee, Claudia Claverie (LS) to deliver the finding regarding the allegation mentioned above. LPA previously met with LS on 05/03/21 and 06/23/21 to discuss the purpose of the visit, to initiate the investigation, and obtained a facility roster of the children in care. It was alleged that the Licensee inappropriately restrained a daycare child (C1) while in care. The report noted LS was sitting on a chair, while C1 was sitting on the floor facing the audience during story time, LS placed both her legs over C1’s shoulders, and C1’s head was in between LS’s legs.

LS admitted to the allegation, claiming she only restrained C1 once during story time between the hour of 8:00am through 9:00am on 04/20/21. She encouraged C1 to sit in between her feet and while her legs were touching C1, LS applied force to hold C1. LS further claimed that she sometimes used her arms and legs to keep C1 down if C1 was trying to get away but that C1’s parent gave LS consent to restrain C1’s movement. (Continue to LIC 9099-C)

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: 07/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021

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-20210426140506

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: CLAVERIE, CLAUDIA FCCH	FACILITY NUMBER: 483008718
	VISIT DATE: 07/26/2021

NARRATIVE

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LS claimed the facility’s standard methods for disciplining child(ren) with challenging behavior comprised of staff talking with the child(ren) and that child would sit next to LS in accordance with that child’s age, or for a period of time until that child(ren) calmed down and/or was ready to be reintegrated with the group.

Through the course of the investigation starting from 04/30/21 through 07/19/21, LPA interviewed LS, one adult, four children, four staff and two parents. Some children were not verbal, too young to interview, or did not qualify to be interviewed. Statements provided by multiple staff, children and parent did not report any concerns at the facility, however; statements provided by one adult and one staff corroborated the allegation. The statements confirmed that the incident occurred on 04/20/21 between 8:30am to 9:00am and the details of those two statements were similar to LS’s statement, also describing as if C1 was being caged in between LS’s legs for up to ten minutes which resulted in C1 screaming for that length of time. The statements further reported that prior to the incident, LS did become impatient with C1.

On 05/03/21, the Department received corroborating evidence which confirmed and further supported claims that LS inappropriately restrained C1. Records showed that LS sat on a chair facing her audience and while she read a book to the children, LS placed both her legs over C1’s shoulders to restrain C1 between LS’s legs which resulted in C1 crying. Based on interviews and records obtained, there is enough corroborating evidence to show that LS inappropriately restrained C1 and thus, LS violated C1’s personal rights. LS did not comply with requirements of California Code of Regulations (CCR), 102423(a)(4). This report was discussed and reviewed with LS, and an Exit interview was conducted. Notice of Site Visit shall be posted for 30 days. Appeal Rights were provided.

Reports citing 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: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021

LIC9099 (FAS) - (06/04)

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Control Number 01-CC-20210426140506

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: CLAVERIE, CLAUDIA FCCH	FACILITY NUMBER: 483008718
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/26/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/26/2021 Section Cited CCR 102423(a)(4)	1 2 3 4 5 6 7	Personal Rights. 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 eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical	1 2 3 4 5 6 7	The Licensee stated since the incident, she learned that child(ren) could not be restrained regardless of parental consent. Licensee stated she intends to review video on children's personal rights on the Department's transparency website and would produce and submit a written statement detailing what she learned and how she intends to prevent and comply with CCR102423(a)(4).
	8 9 10 11 12 13 14	functioning. This requirement is not met as evidenced by: Based on Based on interviews and records obtained, there is enough corroborating evidence to show that LS inappropriately restrained C1 and thus, LS violated C1’s personal rights. This posed an immediate health, safety and personal rights risk to that child in care.	8 9 10 11 12 13 14	In addition, the Licensee intends to train all staff on children's personal rights and the Licensee would submit staff training signature log to the Department by 07/27/21 via mail, email or fax. 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: 07/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021

LIC9099 (FAS) - (06/04)

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