493008417-9-9-2021-01-CC-AHON-C6QTAZ-20210910143420

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 493008417
Report Date: 09/09/2021
Date Signed: 09/09/2021 02:54:10 PM

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
06/23/2021 and conducted by Evaluator Jennifer Velasco

COMPLAINT CONTROL NUMBER: 01-CC-20210623150232

FACILITY NAME:	ROSS, SHAELA FCCH		FACILITY NUMBER:	493008417
ADMINISTRATOR:	ROSS, SHAELA & ROBYN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 483-9741
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95405
CAPACITY:	14	CENSUS:	DATE:	09/09/2021
		UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Shaela Ross, Zen Robyn Ross,		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Licensee used inappropriate form of punishment for day care children

INVESTIGATION FINDINGS:

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An unannounced subsequent complaint investigation inspection was conducted by Licensing Program Analyst Jennifer Velasco (LPA), who met with licensee Shaela Ross (L1). It has been alleged that Licensee used inappropriate forms of punishment for day care children; specifically, that a child (C1) was placed on time out for 30 minutes. L1 denied the allegation and stated no child has been put on time out for a period of minutes in excess of their age. During the course of the investigation, LPA interviewed one witness (A1) on 06/24/2021. On 07/06/2021, LPA reviewed media, toured the facility, obtained facility documents, and interviewed three witnesses (L1, S1, C6). On 07/09/2021, LPA reviewed facility documents and media. On 07/12/2021, LPA toured the facility and interviewed one witness (C6). On 08/11/2021, LPA interviewed two witnesses (A3, A5). On 08/12/2021, LPA interviewed four witnesses (A6, C7, C8, S2). On 08/17/2021, LPA reviewed facility documents and media.

Continued on LIC 9099-C.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Jennifer Velasco	TELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021

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-20210623150232

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: ROSS, SHAELA FCCH	FACILITY NUMBER: 493008417
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/09/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/10/2021 Section Cited CCR 102423(a)(4)	1 2 3 4 5 6 7	Personal rights: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee (L1) stated she will submit to LPA via email by the POC date a detailed written plan to ensure a child is not placed on time out in excess of the child's age in years, with the plan to include details of staff training on behavior management and strategies to manage the length of time outs.
	8 9 10 11 12 13 14	LPA review of media showing a preschool aged child put on time out for 27 minutes. This posed a risk to the health, safety and personal rights of children in care.	8 9 10 11 12 13 14	LPA's email: jennifer.velasco@dss.ca.gov
	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: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Jennifer Velasco	TELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021

LIC9099 (FAS) - (06/04)

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Control Number 01-CC-20210623150232

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: ROSS, SHAELA FCCH	FACILITY NUMBER: 493008417
	VISIT DATE: 09/09/2021

NARRATIVE

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Continued from LIC 9099.

Based on interviews and facility documents and media, the preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. The following violation of the California Code of Regulations, Title 22; Division 6, was observed: see LIC 9099-D. This report was reviewed and discussed with L1. Appeal Rights were provided, and exit interview was conducted. All licensing reports are public information and must be made available upon request for at least three years. Notice of Site Visit shall be posted for 30 days from today’s visit.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Jennifer Velasco	TELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021

LIC9099 (FAS) - (06/04)

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