490102274-5-20-2025-01-CC-LLEI-DGVRBM-20250521125254

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 490102274
Report Date: 05/20/2025
Date Signed: 05/20/2025 02:31:38 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 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
12/11/2024 and conducted by Evaluator Melinda Mohr

PUBLIC

COMPLAINT CONTROL NUMBER: 01-CC-20241211141454

FACILITY NAME:	SUNSHINE NURSERY SCHOOL		FACILITY NUMBER:	490102274
ADMINISTRATOR:	MELISSA SHIELDS		FACILITY TYPE:	850
ADDRESS:	109 PATTEN STREET		TELEPHONE:	(707) 996-2702
CITY:	SONOMA	STATE: CA	ZIP CODE:	95476
CAPACITY:	105	CENSUS: 73	DATE:	05/20/2025
		UNANNOUNCED	TIME BEGAN:	01:28 PM
MET WITH:	Melissa Sheilds		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Facility did not follow reporting requirements

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mindy Mohr made an unannounced complaint investigation visit today and met with Director Melissa Shields for the purpose of delivering findings for the above allegation. It was alleged that the facility did not follow reporting requirements.

On 12/12/2024 LPA Mohr received an email from D1 regarding an injury that occurred at the facility on 12/09/2024. Child (C1) was injured while playing on the monkey bars and required medical treatment. The Department did not receive a telephone call reporting the incident. D1 stated she was unsure the extent of the injury, but did call the Department a few days after the incident occurred and was told at that time to submit the written report.
(continued on LIC9099-C)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melinda Mohr	TELEPHONE: (707) 494-2125
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025

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-20241211141454

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: SUNSHINE NURSERY SCHOOL	FACILITY NUMBER: 490102274
	VISIT DATE: 05/20/2025

NARRATIVE

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Although D1 reported the incident via email the incident was not reported to the Department by telephone or fax within the Department’s next working day and during business hours as required. The facility violated California Code of Regulations (CCR) 101212(d)(1)(B) which required the facility to notify the Department of any injury to any child that requires medical treatment.

Therefore, based on the investigation, the preponderance of evidence standard has been met. The above allegation is found to be substantiated. The following violations of the Health and Safety Code section 1596.895; see LIC 9099D. Appeal rights were provided.
Exit interview was conducted, and report reviewed with Director Melissa Sheilds.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melinda Mohr	TELEPHONE: (707) 494-2125
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025

LIC9099 (FAS) - (06/04)

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Control Number 01-CC-20241211141454

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: SUNSHINE NURSERY SCHOOL	FACILITY NUMBER: 490102274
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/20/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/03/2025 Section Cited CCR 101212(d)(1)(B)	1 2 3 4 5 6 7	(d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours…(1)Events reported shall include the following: (B) Any injury to any child that requires medical treatment. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Director stated she is now aware of the regulations and procedures when there is an incident that occurs and will make sure to report all incidents moving forward.
	8 9 10 11 12 13 14	Based on record review and interview D1 was aware of an incident that occurred on 12/09/2024 and did not report the incident to the Department within the Department’s next working day during normal business hours. This poses a potential health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14
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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: Melinda Mohr	TELEPHONE: (707) 494-2125
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025

LIC9099 (FAS) - (06/04)

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