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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 493009773
Report Date: 05/03/2022
Date Signed: 05/03/2022 12:04:58 PM

Substantiated


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
02/04/2022 and conducted by Evaluator Amy Strother
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20220204123137
FACILITY NAME:PEREZ, EMILIO FCCHFACILITY NUMBER:
493009773
ADMINISTRATOR:EMILIO PEREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 230-1631
CITY:SANTA ROSASTATE: CAZIP CODE:
95407
CAPACITY:14CENSUS: 6DATE:
05/03/2022
UNANNOUNCEDTIME BEGAN:
10:57 AM
MET WITH:Emilio PerezTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Staff does not provide daycare children with adequate supervision

Staff violated child's personal rights
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. LPAs met with Licensee, Emilio Perez. It has been alleged that staff does not provide daycare children with adequate supervision, specifically that a child was in the street outside of the facility unattended by staff and that staff violated child's personal rights, specifically that an infant was in a feeding chair while no longer eating and unattended.

During the initial investigation visit on 02/10/22, LPA requested and received a current roster of children in care, interviewed the Licensee (L1) and one staff, Staff 1 (S1). On 02/10/22 at 9:35am, Licensee corroborated the allegations stating that one day in the last month when the children were outside playing at the neighborhood park, Child 2 (C2) saw their parent drive up and ran into the street. Licensee further stated that infants are placed in infant feeding chairs at times when they are not eating.
Continue on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2022
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-20220204123137
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: 05/03/2022
NARRATIVE
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During the investigation a police report from the Santa Rosa Police Department was obtained and reviewed on 02/03/22 and video footage from the officer’s body camera was obtained and reviewed on 02/28/22. An interview with Adult 1 (A1) on 02/17/22, and a review of police records corroborate that a child, Child 3 (C3) was observed in the street standing between 2 vehicles and that an infant, Child 1 (C1) was sitting in a feeding chair while not eating for at least 9 minutes.

Based on interviews conducted, and records reviewed, the Licensee did not ensure that the outdoor play area was supervised while playing in the unfenced front yard, allowing a child in care to enter the street on more than one occasion and the Licensee allowed an infant to be restrained in a feeding chair while not being feed for at least 9 minutes, which is a violation of their personal rights. The preponderance of evidence standard has been met; therefore, the above allegations are found to be substantiated. California Code of Regulations, Title 22, is being cited on the attached LIC 9099-D. Additionally a $250 Civil Penalty is being assessed for repeat of the same violation of regulation within 12 months. Appeal Rights were provided.

LPAs Strother and Phouthavong informed licensee Emilio Perez that this report dated 05/03/22 documents two Type A citations which shall be posted for 30 consecutive days as there are immediate risks to the health, safety, and personal rights of children in care.

Also, LPA Strother informed the licensee to provide a copy of this licensing report dated 05/03/22, 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 License, Emilio Perez. 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 HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 01-CC-20220204123137
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: 05/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/04/2022
Section Cited
CCR
102417(g)(6)
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Operation of a Family Child Care Home (g)…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.

This requirement was not met as evidenced by:
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Licensee stated the park will be used during the hours of 10:30am-12:00pm, only when two staff are able to go to the park. Children will hold a rope to walk to and from the park with one staff in front and one in back. One staff will always be positioned at the edge of the park
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Based on interviews and record review, the licensee did not supervise children while exiting the home or playing at the neighborhood park allowing access to the street which poses an immediate health, safety, or personal rights risk to the children in care.
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closet to the street for supervision and blocking children from entering the street.
Type A
05/04/2022
Section Cited
CCR
102423(a)(2)
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(a)Each child...shall have certain rights that shall not be waived...regardless of consent or authorization from the child's authorized representative. ...not limited to, the following: (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
This requirement was not met as evidenced by:
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Licensee stated that he no longer uses the feeding chairs beyond feeding time. Infants are placed in feeding chairs after washing hands, they are fed and then taken out of feeding chair. Licensee stated a play yard will be used as a safe area that an infant can be placed
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Based on interviews and record review Child 1 (C1) was observed to be in a feeding chair for at least 9 minutes and not being fed, therefore restraining the child, which poses an immediate health, safety, or personal rights risk to the children in care.
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while staff are cleaning up lunch and getting older children outside. Once lunch is cleaned up, staff will remove infant(s) from play yard to join the group.
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 HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3