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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 490107083
Report Date: 01/13/2020
Date Signed: 01/13/2020 02:32:09 PM



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
12/03/2019 and conducted by Evaluator Amy Strother
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20191203114821
FACILITY NAME:J.X. WILSON EXTENDED CHILD CAREFACILITY NUMBER:
490107083
ADMINISTRATOR:CHRISTY CALVERLEYFACILITY TYPE:
840
ADDRESS:246 BRITTAIN LANETELEPHONE:
(707) 545-2402
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY:96CENSUS: 14DATE:
01/13/2020
UNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Cristina NorthcroftTIME COMPLETED:
02:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff failed to provide adequate supervision resulting in a child being inappropriately touched by another child.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Amy Strother made a subsequent unannounced complaint investigation inspection for the purpose of delivering complaint findings, and met with Center Director, Cristina Northcroft. It has been alleged that staff failed to provide adequate supervision resulting in a child being inappropriately touched by another child.

During the initial investigation inspection on 12/06/19, LPA Strother conducted interviews at 12:00pm with Adult 1 – Adult 3 (A1-A3) and obtained records and at 2:13pm with Staff 1 (S1) and obtained records. During the subsequent investigation on 12/10/19 at 1:35pm LPA Strother conducted interviews with Staff 2 – Staff 4 (S2-S4) and Child 1 – Child 3 (C1-C3). On 12/17/19 at 1:24pm LPA Strother conducted telephone interviews with Adult 4 and Adult 5 (A4 and A5). Interviews with Adults, Staff and Children do not corroborate that there was a lack of supervision or that inappropriate touching between children occurred.

Continue LIC9099-C

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2020
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-20191203114821
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: J.X. WILSON EXTENDED CHILD CARE
FACILITY NUMBER: 490107083
VISIT DATE: 01/13/2020
NARRATIVE
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Based on interviews conducted and records reviewed, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are unsubstantiated. An exit interview was conducted. The notice of Site Visit must be posted for 30 days.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2