493008731-9-23-2019-01-CC-AHON-BGEL75-20190927082944

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 493008731
Report Date: 09/23/2019
Date Signed: 09/23/2019 05:42:06 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/01/2019 and conducted by Evaluator Amy Strother

COMPLAINT CONTROL NUMBER: 01-CC-20190701140518

FACILITY NAME:	TERRY, TERESA FCCH		FACILITY NUMBER:	493008731
ADMINISTRATOR:	TERRY, TERESA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 261-3601
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95404
CAPACITY:	14	CENSUS: 6	DATE:	09/23/2019
		UNANNOUNCED	TIME BEGAN:	04:30 PM
MET WITH:	Simona Escoban		TIME COMPLETED:	05:55 PM

ALLEGATION(S):

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Licensee operating beyond the terms and conditions of the license

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Amy Strother made a subsequent complaint investigation inspection, for the purpose of delivering complaint findings, and met with assistant, Staff 1 (S1). S1 stated that the Licensee is currently on vacation. S1 was able to get the Licensee on the phone. LPA read this report to the Licensee over the phone. It is alleged that the Licensee was operating beyond the terms and conditions of the license, specifically that on 6/27/19 the Licensee was without an assistant and supervising 9 children, which included 3 infants.

Interviews were conducted with the Licensee and Staff 1 (S1) on 7/03/19 at 3:05 p.m. The Licensee stated that on 6/27/19, her assistant was running late. Interviews confirm that on 6/27/19, from 8:25 a.m. to approximately 9:00 a.m., the Licensee was alone and supervising 9 children, which included 3 infants, until her assistant S1 arrived.

Continue on LIC9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2019

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-20190701140518

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: TERRY, TERESA FCCH	FACILITY NUMBER: 493008731
	VISIT DATE: 09/23/2019

NARRATIVE

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The Licensee has a Large Family Child Care Home (FCCH), but without a qualified assistant present, the Licensee must adhere to Small FCCH capacity and ratio requirements. The maximum Small FCCH capacity is 8 children, therefore, the Licensee was over capacity with 1 additional child in care.

The maximum number of infants allowed, when operating within the ratio requirements of a Small FCCH, at a capacity of 8, is no more than 2 infants. Therefore, the Licensee was also operating out of ratio with 1 additional infant in care.

When more than 6 children are in care, there must be 2 school age children, including 1 child that is at least 6 years old and another child that is enrolled and attending Kindergarten. The Licensee was caring for 1 child who was over 6 years old, but there was not another child that was enrolled and attending Kindergarten, therefore the Licensee was operating out of ratio.

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 6, is being cited on the attached LIC 9099D. This report was reviewed and discussed with the Assistant and the Licensee. Appeal Rights were provided and exit interview was conducted. At 5:18pm Licensee gave permission during a phone call for her assistant, S1 to sign all licensing reports during this inspection.

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: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2019

LIC9099 (FAS) - (06/04)

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Control Number 01-CC-20190701140518

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: TERRY, TERESA FCCH	FACILITY NUMBER: 493008731
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/23/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/23/2019 Section Cited CCR 102416.5(a)	1 2 3 4 5 6 7	102416.5 Staffing Ratio and Capacity(a)The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee stated any parent requests for changes to the children's schedules will need 24 hour notice and are subject to Licensee's approval. Licensee stated that she has also scheduled her assistant 30 minutes prior to the ratio and capacity changing from operating as a small FCCH to a large FCCH.
	8 9 10 11 12 13 14	Based on interview, the licensee failed to maintain the capacity specified on the license. On 6/27/19 the licensee was supervising 9 children, which included 3 infants without an assistant, which poses a potential Heath, Safety or 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: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2019

LIC9099 (FAS) - (06/04)

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