493002686-6-9-2022-01-CC-AHON-CFFVCT-20220616161936

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 493002686
Report Date: 06/09/2022
Date Signed: 06/09/2022 12:00:38 PM

Unsubstantiated

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
03/30/2022 and conducted by Evaluator Sebastian Phouthavong

PUBLIC

COMPLAINT CONTROL NUMBER: 01-CC-20220330115216

FACILITY NAME:	TINY TREASURES PRESCHOOL, INC.		FACILITY NUMBER:	493002686
ADMINISTRATOR:	FIORI, ELIZABETH		FACILITY TYPE:	850
ADDRESS:	180 WIKIUP DRIVE		TELEPHONE:	(707) 544-8469
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95403
CAPACITY:	60	CENSUS: 54	DATE:	06/09/2022
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Pam McDonald		TIME COMPLETED:	12:10 PM

ALLEGATION(S):

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Administrator is not notifying parents of COVID outbreak

INVESTIGATION FINDINGS:

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A subsequent complaint investigation inspection was conducted at the facility by Licensing Program Analysts (LPAs), Amy Strother and Sebastian Phouthavong to deliver complaint investigation findings. It has been alleged that Administrator is not notifying parents of COVID outbreak. During today’s visit, LPAs met with Center Director, Pam McDonald.
An initial investigation visit was made by the LPAs on 04/06/22, meeting with Licensee Beth Fiori and Center Director Pam McDonald. During the visit on 04/06/22, LPAs requested and received a copy of facility documents and interviewed the Licensee (L1) and Center Director (D1). On 04/08/22 screen shots of communication with parents/authorized representatives on the BrightWheel App. from L1 related to communication about positive COVID-19 cases were received by LPA Phouthavong. During the compliant investigation, LPAs interviewed three parents, Adult 1 – Adult 3 (A1-A3) and attempted to interview Adult 4 (A4) between 04/05/22 and 05/10/22, and received records of communication with the facility from the BrightWheel App.
(Continue on LIC 9099-C )

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Sebastian Phouthavong	TELEPHONE: 707-588-5056
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

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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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
03/30/2022 and conducted by Evaluator Sebastian Phouthavong

PUBLIC

COMPLAINT CONTROL NUMBER: 01-CC-20220330115216

FACILITY NAME:	TINY TREASURES PRESCHOOL, INC.		FACILITY NUMBER:	493002686
ADMINISTRATOR:	FIORI, ELIZABETH		FACILITY TYPE:	850
ADDRESS:	180 WIKIUP DRIVE		TELEPHONE:	(707) 544-8469
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95403
CAPACITY:	88	CENSUS: 54	DATE:	06/09/2022
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Pam McDonald		TIME COMPLETED:	12:10 PM

ALLEGATION(S):

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Administrator did not report unusual incident to CCL

INVESTIGATION FINDINGS:

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A subsequent complaint investigation inspection was conducted at the facility by Licensing Program Analysts (LPAs), Amy Strother and Sebastian Phouthavong to deliver complaint investigation findings. It has been alleged that Administrator did not report unusual incident to Community Care Licensing (CCL), specifically that Administrator did not report cases of COVID to CCL. LPAs met with Center Director, Pam McDonald.
An initial investigation visit was made by the LPAs on 04/06/22, meeting with Licensee Beth Fiori and center director Pam McDonald. During the visit on 04/06/22, LPAs requested and received a copy of facility documents and interviewed the Licensee (L1) and Center Director (D1).
During the interviews L1 and D1 both stated that there have been positive COVID-19 cases at the facility and they did not notify Public Health or CCL, corroborating the allegation.
(Continue on LIC 9099-C )

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Sebastian Phouthavong	TELEPHONE: 707-588-5056
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 01-CC-20220330115216

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: TINY TREASURES PRESCHOOL, INC.	FACILITY NUMBER: 493002686
	VISIT DATE: 06/09/2022

NARRATIVE

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Based on interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. The following violation of the California Code of Regulations, Title 22: Division 12, were observed: See LIC9099D. Appeal Rights were provided.

An exit interview was conducted and Plans of corrections were reviewed and developed with Facility Representative, Pam McDonald.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Sebastian Phouthavong	TELEPHONE: 707-588-5056
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

LIC9099 (FAS) - (06/04)

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Control Number 01-CC-20220330115216

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: TINY TREASURES PRESCHOOL, INC.	FACILITY NUMBER: 493002686
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/09/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/23/2022 Section Cited CCR 101212(d)(1)(E)	1 2 3 4 5 6 7	(d) Upon the occurrence...of any of the events specified in (d)(1) below, a report shall be made to the Department... by... next working day...In addition, a written report containing the information specified in (d)(2)...submitted to the Department within seven days...(1) ...include...(E) Epidemic outbreaks. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	D1 stated D1 will work with L1 to submit a Usual Incident Report regarding the COVID-19 Cases occurring in March and April of 2022 to LPA, S. Phouthavong at Sebastian.phouthavong@dss.ca.gov by 06/23/22. L1 will also submit the facility’s written procedure for reporting any future COVID-19 Positives cases signed and dated to CCL, sending it to the email above.
	8 9 10 11 12 13 14	Based on interviews with L1 and D1 stated that the facility has had multiple occasion when a child enrolled at the facility or staff working at the facility tested positive for COVID-19 and the facility did not report the incident to Public Health or to Community Care Licensing, which poses a potential health and safety and personal rights risk to the children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	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: Sebastian Phouthavong	TELEPHONE: 707-588-5056
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

LIC9099 (FAS) - (06/04)

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Control Number 01-CC-20220330115216

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: TINY TREASURES PRESCHOOL, INC.	FACILITY NUMBER: 493002686
	VISIT DATE: 06/09/2022

NARRATIVE

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L1 and D1 stated during interviews that information regarding COVID-19 positives was only being sent to the parents of the children who were enrolled in the same classroom where the person who tested positive attends. A review of records indicates that BrightWheel messages were sent to families regarding COVID-19 positives as follows: on 03/28/22 to families enrolled in Staff 3 (S3’s) class, 03/30/22 to the families from Staff 2 (S2’s) classroom and on 04/04/22 to all school families regarding S3 and Staff 1 (S1’s) classrooms. All Adults (A1-A3) stated that they have received information from the facility about COVID-19 positives for the specific classroom that their child attended. A1 and A2 stated that there was communication from the facility on 03/30/22 asking parents if they wanted to know when a child or staff from any classroom tests positive and then on 04/04/22 began receiving messages on the BrightWheel App regarding all classrooms where COVID-19 positives had been reported.
Although a notification regarding a positive COVID-19 case in a classroom did not go out to all parents or authorized representatives of the children enrolled at the facility, based on information gathered during interviews and record review, there was sufficient evidence to support that the facility did notify parents or authorized representative of the children enrolled in the specific classroom where a COVID-19 positive case was present. Evidence also supports that once a parent requested to receive notifications when a positive COVID-19 case occurs in any classroom, the facility did make the requested change and began notifying parents or authorized representatives of all COVID-19 cases connected to the facility, beginning on 04/04/22. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

There were no Title 22 deficiencies cited based on the above findings. Exit interview conducted and report was reviewed with facility representative, Pam McDonald. Appeal rights were provided.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Sebastian Phouthavong	TELEPHONE: 707-588-5056
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

LIC9099 (FAS) - (06/04)

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