493009773-2-3-2022-01-CC-AHON-CBVNSJ-20220222094309

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 493009773
Report Date: 02/03/2022
Date Signed: 02/03/2022 12:53:58 PM

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
01/28/2022 and conducted by Evaluator Amy Strother

PUBLIC

COMPLAINT CONTROL NUMBER: 01-CC-20220128161720

FACILITY NAME:	PEREZ, EMILIO FCCH		FACILITY NUMBER:	493009773
ADMINISTRATOR:	EMILIO PEREZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 230-1631
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95407
CAPACITY:	14	CENSUS: 10	DATE:	02/03/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Maria Medina		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Licensee does not provide daycare children with adequate supervision.

INVESTIGATION FINDINGS:

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An unannounced complaint investigation visit was made to the facility by Licensing Program Analyst (LPA), Amy Strother to investigate an allegation filed against the facility. It has been alleged that Licensee does not provide daycare children with adequate supervision, specifically that children in care have had access to a neighbor’s backyard, due to the facilities fence being in disrepair.

LPA Strother met with assistant, Maria Medina, Staff 1 (S1). S1 and Staff 2 (S2) were supervising 10 children, operating within the licensed capacity and ratio requirements. S1 was interviewed at 11:15am, stating that children were playing outside on 02/02/22, the day after fence boards fell down, on 02/01/22. S1 stated that there was not a staff person present during the time that the fence boards fell, and that she had gone inside to get something when the incident occurred. During the visit, LPA toured the facility and obtained a roster. LPA observed approximately 4 fence boards missing from the fence on the left side of the yard.The gap in the fence was barricaded with a BBQ, painting easel and garbage cans.
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: 02/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022

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-20220128161720

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: PEREZ, EMILIO FCCH	FACILITY NUMBER: 493009773
	VISIT DATE: 02/03/2022

NARRATIVE

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LPA observed that the bottom portion of the fence on the back of the property was in disrepair with 7 nail points exposed. Photo documentation was obtained. Children were not observed playing in the backyard during the inspection.

During the course of the investigation LPA interviewed 2 adults, Adult 1 and Adult 2 (A1 and A2) who stated that on more than one occasion multiple fence boards have been broken off of the fence. Adults interviewed stated that on one occasion, approximately 1.5 months ago, up to 3 children were observed in the neighbor’s backyard, unsupervised, stating that the children were returned to the facility through the gap in the fence after calling out for an adult, who then appeared into sight, once called. On 02/02/22 the Department received corroborating evidence which confirmed that one child was observed holding a fence board in their hand, allowing access into a neighboring property while unsupervised.
Based on interviews conducted, and records reviewed, the Licensee did not ensure that the outdoor play area was supervised while the fence was in disrepair and not fully enclosed. 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.
LPA Strother informed facility representative, Maria Medina and licensee Emilio Perez over the phone, that this report dated 02/03/22 documents one Type A citation. Type A citations which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.
Also, LPA Strother informed facility representative and the licensee to provide a copy of this licensing report dated 02/03/22, that documents a Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
Exit interview conducted and report was reviewed with the facility representative, Maria Medina. 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: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022

LIC9099 (FAS) - (06/04)

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Control Number 01-CC-20220128161720

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: PEREZ, EMILIO FCCH	FACILITY NUMBER: 493009773
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/03/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/04/2022 Section Cited CCR 102417(g)(6)	1 2 3 4 5 6 7	102417 Operation of a Family Child Care Home (g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: (6) Outdoor play areas shall be either fenced, or outdoor play shall be supervised by the licensee or caregiver.	1 2 3 4 5 6 7	Licensee (L1) stated that the backyard will be off limits effective today 2/3/22. L1 will submit an updated LIC999A Yard Sketch to LPA by 02/04/22 by text or email to 707-599-1479 or amy.strother@dss.ca.gov. L1 stated that the fence will be replaced or repaired as needed as soon as possible.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: interviews conducted and evidence reviewed corroborate that children were playing in the backyard while fence boards were broken, without direct supervision, which poses an immediate health and safety risk to the children in care.	8 9 10 11 12 13 14	L1 stated he has an appointment with a repair person today, 02/03/22 at 2:00pm. L1 stated once the backyard is fully fenced and in good repair, L1 will submit an updated LIC999A yard sketch requesting LPA to inspect the backyard to place it back on-limits.
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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.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022

LIC9099 (FAS) - (06/04)

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