490109162-3-22-2022-01-CC-LLEI-CFLPQ8-20220621113041

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 490109162
Report Date: 03/22/2022
Date Signed: 03/22/2022 03:28:05 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/14/2022 and conducted by Evaluator Kevin O'Connell

COMPLAINT CONTROL NUMBER: 01-CC-20220314105457

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:	45	CENSUS: 36	DATE:	03/22/2022
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Michaela Murray, Director		TIME COMPLETED:	02:10 PM

ALLEGATION(S):

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Day care child was able to leave the facility unsupervised.

INVESTIGATION FINDINGS:

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LPA (Licensing Program Analyst) Kevin O'Connell made an unannounced visit to investigate the above allegation. LPA met with Michaela Murray, Director, (S1) at 11:30 am, 3/22/22 and discussed the allegation. It was alleged that a day care child was able to leave the facility unsupervised. S1 acknowleged that the incident did happen as S1 self reported this as a Unusual Incident the day of the elopement.
(This was reported to CCL before the complaint was alleged).
A child (C1) wandered away during a transition to the play yard while the teacher (S2) was attending to a child (C2) who had just tripped and fell and needed assitance. C1 was found by a person passing by as C1 was heading towards a convenience store on the street in front of the day care center.

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: 03/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022

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-20220314105457

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: OLD ADOBE SCHOOL	FACILITY NUMBER: 490109162
	VISIT DATE: 03/22/2022

NARRATIVE

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Approximately 20 minutes later a policeman and C1 were observed by S1 across the street walking towards the center when S1 saw them and walked to meet them and all returned to the center.
LPA interviewed S1 and reviewed the Incident Report.
Based on the interview, document review and S1's acknowledgement of the incident, the preponderance of evidence standard has been met; therefore, the above allegation is found to be substantiated. California Code of Regulations, Title 22, is being cited on the attached LIC 9099-D. Appeal rights were provided. An exit interview was conducted, and this report as well as the deficiencies page was read and discussed with the Director, S1. The Notice of Site Visit shall be posted for 30 days.

Reports citing Type A violations are to be provided to parents/guardians of children currently enrolled and to parents/guardians of children newly enrolled at the facility during the next twelve 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: Kevin O'Connell	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022

LIC9099 (FAS) - (06/04)

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Control Number 01-CC-20220314105457

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: OLD ADOBE SCHOOL	FACILITY NUMBER: 490109162
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/22/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/23/2022 Section Cited HSC 1596.99(c)(3)	1 2 3 4 5 6 7	1596.99 Levy of civil penalty in addition to suspension, temporary suspension, or revocation; amounts; regulations setting forth appeal procedures for deficiencies	1 2 3 4 5 6 7	S1 will impliment a policy to have more than one teacher transition children to the play yard. S1 will provide CCl a copy of the new policy that was distributed to the staff and parents by 3/23/22.
	8 9 10 11 12 13 14	The department shall assess an immediate civil penalty of five hundred dollars ($500) per violation and one hundred dollars ($100) for each day the violation continues after citation, for any of the following serious violations: Absence of supervision, including, but not limited to, a child left unattended, and supervision of a child by a person under 18 years of age. This requirement was not met as evidenced by: Director self reporting elopement and acknowledging that child C1 left the center without supervision. This poses an immediate health, safety or personal rights risk to the children in care. A Civil Penalty will be issued. Reports citing Type A violations are to be provided to parents/guardians of children currently enrolled and to parents/guardians of children newly enrolled at the facility during the next twelve months. Parents/guardians must sign form LIC9224 to be kept in each child’s file.	8 9 10 11 12 13 14	kevin.oconnell@dss.ca.gov
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	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: 03/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022

LIC9099 (FAS) - (06/04)

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