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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 490111750
Report Date: 09/01/2023
Date Signed: 09/01/2023 02:53:00 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
07/31/2023 and conducted by Evaluator Robert Maciel
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20230731100524
FACILITY NAME:REDWOOD COUNTRY KIDS CLUBFACILITY NUMBER:
490111750
ADMINISTRATOR:YOUNG, NANCYFACILITY TYPE:
840
ADDRESS:1340 MEDICAL CENTERTELEPHONE:
(707) 586-0675
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY:110CENSUS: 0DATE:
09/01/2023
UNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Nancy YoungTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff allowed children in care to be left unsupervised
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Robert Maciel made a subsequent complaint-investigation visit and met with Director, Nancy Young (D1) for the purpose of delivering finding for the above allegation. LPA previously met with D1 on 08/10/23 to initiate the investigation by discussing the purpose of the visit, conducting interviews with D1 and staff, making observations; and requesting a facility roster of the children currently in care. It was alleged that a children in care were allowed to be left unsupervised while inside the facility.

LPA Maciel interviewed D1, three staff (S1, S2, and S3), and one adult (RP) from 8/8/23 through 8/10/23. D1 stated that given the age of the children attending, constant supervision when they are travelling between areas is not necessary. S1, S2, and S3 all stated that the facility utilizes a two-person buddy system for children to travel between areas of the facility without adult supervision. During the visit on 8/10/23, LPA observed children travelling between different rooms of the facility without adult supervision. Continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023
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 3
Control Number 01-CC-20230731100524
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: REDWOOD COUNTRY KIDS CLUB
FACILITY NUMBER: 490111750
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/01/2023
Section Cited
CCR
101229(a)(1)
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No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
This requirement is not met as evidenced by:
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Director stated she would send in a written plan of correction to the LPA within 30 days. robert.maciel@dss.ca.gov
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Based on observations and interviews, the licensee did not ensure constant supervision of children in care which poses a potential health and safety risk to the children in care.
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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.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 01-CC-20230731100524
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: REDWOOD COUNTRY KIDS CLUB
FACILITY NUMBER: 490111750
VISIT DATE: 09/01/2023
NARRATIVE
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Based on the evidence obtained, 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 9099D. Appeal rights were provided and exit interview conducted. The Notice of Site Visit must be posted for 30 days.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3