173002889-12-26-2025-01-CC-MMOR-DPTLFP-20251229074328

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 173002889
Report Date: 12/26/2025
Date Signed: 12/26/2025 03:03:18 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC RO, 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
10/02/2025 and conducted by Evaluator Sebastian Phouthavong

PUBLIC

COMPLAINT CONTROL NUMBER: 01-CC-20251002150712

FACILITY NAME:	YUBA COMMUNITY COLLEGE,LAKE CAMPUS CDC		FACILITY NUMBER:	173002889
ADMINISTRATOR:	BLAKE, CHERYL		FACILITY TYPE:	850
ADDRESS:	15880 DAM ROAD EXTENSION		TELEPHONE:	(707) 995-7909
CITY:	CLEARLAKE	STATE: CA	ZIP CODE:	95422
CAPACITY:	30	CENSUS:	DATE:	12/26/2025
		UNANNOUNCED	TIME BEGAN:	03:06 PM
MET WITH:			TIME COMPLETED:	03:20 PM

ALLEGATION(S):

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Child sustained unexplained bruises while in care

INVESTIGATION FINDINGS:

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A complaint investigation was made by Licensing Program Analyst (LPA), Sebastian Phouthavong. LPA previously conducted an inspection on 10/06/2025 to initiate the investigation and met with Area Director, Patricia Ryan (AD) to discuss the allegations, conduct interviews, and to make observations. However, the facility was temporarily closed during the visit. It was alleged a Child sustained unexplained bruises while in care.
During the course of the investigation, LPA conducted interviews with Area Director (AD), one staff (S4), five adult (A2 – A6) and attempted three additional adult interviews from 10/06/2025 to 12/23/2025. AD denied the allegation. AD stated that they never received any notification of injuries from staff. However, AD stated that they were later notified by a daycare parent that their child had sustained bruises on their body, and AD was unsure whether the bruises occurred while the child was at the facility. Interview from Staff (S4) also stated to have never heard of any incidents in which a child was injured. In addition, AD and S4 stated that staff are to notify parents of any incidents involving their children.
(Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Melinda Mohr
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:	DATE: 12/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2025

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-20251002150712

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: YUBA COMMUNITY COLLEGE,LAKE CAMPUS CDC	FACILITY NUMBER: 173002889
	VISIT DATE: 12/26/2025

NARRATIVE

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(Continued from LIC9099)
According to Adult interviews (A2 & A5) stated that they observed unknown bruises and cuts on their children and were never notified about these injuries by the facility. No corroborating evidence was revealed to determine whether unexplained bruises occurred while at the facility.

Based on the information gathered during this investigation, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations occurred and therefore are determined to be unsubstantiated. There were no Title 22 deficiencies cited. Due to the facility being in inactive status, this report will be emailed to Area Director, Patricia Ryan (AD). Appeal rights were provided.

SUPERVISORS NAME: Melinda Mohr
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:	DATE: 12/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2025

LIC9099 (FAS) - (06/04)

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