490109162-8-4-2021-01-CC-LLEI-C5SUKT-20210811153938

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 490109162
Report Date: 08/04/2021
Date Signed: 08/04/2021 11:19:59 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/05/2021 and conducted by Evaluator Kevin O'Connell

PUBLIC

COMPLAINT CONTROL NUMBER: 01-CC-20210505145038

FACILITY NAME:	OLD ADOBE SCHOOL		FACILITY NUMBER:	490109162
ADMINISTRATOR:	MURRAY, MICHAELA		FACILITY TYPE:	850
ADDRESS:	252 WEST SPAIN STREET		TELEPHONE:	(707) 408-2383
CITY:	SONOMA	STATE: CA	ZIP CODE:	95476
CAPACITY:	30	CENSUS:	DATE:	08/04/2021
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Michaela Murray, Director		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Uncleared adults are providing care and supervision to daycare children

INVESTIGATION FINDINGS:

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LPA Kevin O’Connell conducted a subsequent complaint inspection on 8/4/2021 at 9:05am for the purpose of delivering findings for the above allegation. LPA previously met with the Center Director on 5/7/2021 Via Zoom because of Covid to discuss the allegation and request employee/children rosters and personnel reports. It was alleged that uncleared adults are providing care and supervision to daycare children.
S1 denied the allegation at 1:05pm 5/7/21 stating that she was not sure who that would be and further advised what the hiring process entailed regarding ensuring new hires are cleared and associated to the facility prior to employment.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'Connell	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021

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-20210505145038

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: OLD ADOBE SCHOOL	FACILITY NUMBER: 490109162
	VISIT DATE: 08/04/2021

NARRATIVE

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The investigation further consisted of staff interviews and review of requested documents as provided by S1. A review of the facility’s personnel reports in comparison to the Department’s background clearance database revealed that S2 did not have a criminal record clearance, during the course of employment, as required by California Code of Regulations 101170(e)(1). Furthermore, records, including the facility’s personnel reports, showed that S2 worked at the facility for more than five days without clearance.

Based on interviews and document review, the preponderance of evidence standard has been met; therefore, the above allegation is found to be substantiated which will result in a civil penalty of $500 for allowing a staff person to work at the facility without a criminal record clearance. See 9099D for deficiency. Appeal Rights were given. Notice of Site Visit is to be posted for 30 days. Complaint report is to be posted for 30 days.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'Connell	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021

LIC9099 (FAS) - (06/04)

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Control Number 01-CC-20210505145038

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: OLD ADOBE SCHOOL	FACILITY NUMBER: 490109162
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/04/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/04/2021 Section Cited CCR 101170(e)(1)	1 2 3 4 5 6 7	(e)All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to	1 2 3 4 5 6 7	S1 stated that she will review Criminal Record Clearance Regulation 101170 and Health & Safety code 1596.871 on
	8 9 10 11 12 13 14	working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement is not met as evidenced by: Based on interviews conducted and fingerprint document/record reviews, the licensee failed to ensure that S2 was fingerprint background cleared or has an approved criminal record exemption prior to employment and worked at the facility for more than five days which poses an immediate health and safety risk to children in care and an immediate $500 Civil Penalty has been assessed.	8 9 10 11 12 13 14	Fingerprint & criminal record information and will submit a statement of acknowledgement of review and understanding to CCL by 8/5/21. kevin.oconnell@dss.ca.gov 707 494-2125
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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: Kevin O'Connell	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021

LIC9099 (FAS) - (06/04)

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