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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 233009332
Report Date: 12/05/2022
Date Signed: 12/08/2022 10:36:45 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
11/28/2022 and conducted by Evaluator Leticia Rosales
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20221128140920
FACILITY NAME:HENDRICKS, KRISTINE FCCHFACILITY NUMBER:
233009332
ADMINISTRATOR:HENDRICKS, KRISTINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 962-3003
CITY:FORT BRAGGSTATE: CAZIP CODE:
95437
CAPACITY:14CENSUS: 1DATE:
12/05/2022
UNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Kristine HendricksTIME COMPLETED:
04:50 PM
ALLEGATION(S):
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Licensee does not live in the home.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Leticia Rosales-Meza conducted a complaint investigation inspection and met with Licensee, Kristine Hendricks. It has been alleged that the licensee does not live in the home, specifically that the licensee leaves the Family Child Care Home (FCCH) every day in the evening and comes back the next morning, and keeps her possessions at the FCCH to make it look like she lives there. An interview was conducted with Licensee on 12/05/22 at 1:26 PM. Licensee stated she lives in the home.

Photographic evidence was reviewed which includes the licensee’s absence from the FCCH on Monday 11/07/22 at 6:38am, Licensee arrives at 8:13am, leaves at 5:22pm, and was not at the FCCH at 8:10pm. On Tuesday 11/08/22 at 1:41am Licensee was not at the FCCH, at 7:02am Licensee was not at the FCCH, Licensee arrives at 7:18am, and leaves at 3:47pm.

Continue on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Leticia Rosales
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2022
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 4
Control Number 01-CC-20221128140920
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: HENDRICKS, KRISTINE FCCH
FACILITY NUMBER: 233009332
VISIT DATE: 12/05/2022
NARRATIVE
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On Wednesday 11/09/22 at 12:25am Licensee was not at the FCCH, at 6:41am Licensee was not at the FCCH, Licensee arrives at 7:01am, and was not at the FCCH at 7:38pm. On Thursday 11/10/22 at 6:33am Licensee was not at the FCCH, Licensee arrives at 6:46am, and was not at the FCCH at 4:23pm or 10:03pm. On Friday 11/11/22 at 6:25am Licensee was not at the FCCH. Additional photographic evidence was reviewed which includes the licensee’s absence from the FCCH on Wednesday 4/27/22 at 9:15pm, Thursday 4/28/22 at 10:36pm, Wednesday 5/04/22 at 9:44pm, Friday 5/06/22 at 10:05pm, Monday 5/09/22 at 10:07pm, Tuesday 5/10/22 at 10:28pm, Thursday 5/12/22 at 10:23pm, Monday 5/23/22 at 10:09pm, Tuesday 5/24/22 at 10:21pm, and Wednesday 5/25/22 at 10:28pm. Based on photographic evidence the preponderance of evidence standard has been met, therefore, the allegation is Substantiated.

The following violations of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 9099D. Appeal Rights were provided. Exit interview was conducted and report was reviewed and discussed with the Licensee, Kristine Hendricks.

A notice of site visit was given and must remain posted for 30 days from today's date.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Leticia Rosales
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 01-CC-20221128140920
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: HENDRICKS, KRISTINE FCCH
FACILITY NUMBER: 233009332
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
12/20/2022
Section Cited
CCR
102352(f)(1)
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Family Day Care" or "Family Child Care" means regularly provided care, protection and supervision of children, in the care giver's own home....
This requirement is not met as evidenced by:
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Licensee stated that she will submit a written plan of correction within 15 days to the to the Department.

Email: leticia.rosales@dss.ca.gov
Fax: 707-588-5099
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Based on photographics.
This poses a potential Health, and Safety risk to the children in care.
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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.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Leticia Rosales
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4
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
11/28/2022 and conducted by Evaluator Leticia Rosales
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20221128140920

FACILITY NAME:HENDRICKS, KRISTINE FCCHFACILITY NUMBER:
233009332
ADMINISTRATOR:HENDRICKS, KRISTINEFACILITY TYPE:
810
ADDRESS:310 SOUTH FRANKLIN STREETTELEPHONE:
(707) 962-3003
CITY:FORT BRAGGSTATE: CAZIP CODE:
95437
CAPACITY:14CENSUS: 1DATE:
12/05/2022
UNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Kristine HendricksTIME COMPLETED:
04:50 PM
ALLEGATION(S):
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Licensee retaliated against person/persons who filed a complaint.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Leticia Rosales-Meza conducted a complaint investigation inspection and met with licensee Kristine Hendricks. It has been alleged that Licensee retaliated against person/persons who filed a complaint. An interview was conducted with Licensee on 12/05/22 at 2:40 PM. Licensee stated she has not retaliated against anyone.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, therefore the allegation is Unsubstantiated. There was not a Title 22 deficiency cited based on the above finding. Appeal rights were provided. Exit interview conducted and report was reviewed and discussed with licensee Kristine Hendricks.

A notice of site visit was given and must remain posted for 30 days from today's date.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Leticia Rosales
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4