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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 283008570
Report Date: 01/09/2025
Date Signed: 01/09/2025 10:35:47 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA 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
12/31/2024 and conducted by Evaluator Melinda Mohr
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20241231143737
FACILITY NAME:HOPP, TIFFANY FCCHFACILITY NUMBER:
283008570
ADMINISTRATOR:HOPP, TIFFANYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 363-4319
CITY:NAPASTATE: CAZIP CODE:
94558
CAPACITY:14CENSUS: 0DATE:
01/09/2025
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Tiffany HoppTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Uncleared adult residing in the home
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) M. Mohr made an unannounced complaint investigation visit today and met with Licensee Tiffany Hopp (L1). It is alleged there is an uncleared adult residing in the home. LPA toured the home and received documents pertaining to the investigation.

Upon arrival LPA observed there were no children in care. LPA interviewed Licensee, who admitted A1 has been staying with her since June 2024. L1 also stated A1 has been in the home when children were present, but not in the same room with the children. L1 was advised A1 cannot reside in the home until they receive a criminal record clearance. L1 stated she understands that all adults 18 and over living or working in the home must obtain a criminal record clearance or exemption prior to their initial presence in a licensed FCCH.

Continued on LIC9099-C

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melinda Mohr
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025
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-20241231143737
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: HOPP, TIFFANY FCCH
FACILITY NUMBER: 283008570
VISIT DATE: 01/09/2025
NARRATIVE
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Based on the investigation, the preponderance of evidence standard has been met. Therefore, the above allegations are found to be substantiated. The following violations of the California Code of Regulations, Title 22; Division 12: see LIC 9099D. An immediate $500 Civil Penalty is being assessed today. Appeal Rights were provided.

LPA Mindy Mohr informed licensee that this report dated 01/09/2025 documents one Type A citation 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 Mindy Mohr informed the licensee to provide a copy of this licensing report dated 01/09/2025 that documents any Type A citation(s) 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 Licensee Tiffany Hopp..

A notice of site visit was given to facility representative and must remain posted for 30 days

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melinda Mohr
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 01-CC-20241231143737
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: HOPP, TIFFANY FCCH
FACILITY NUMBER: 283008570
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/10/2025
Section Cited
CCR
102370(d)(1)
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(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing… in a licensed facility: (1)Obtain a California clearance or a criminal record exemption as required by the Department
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L1 stated she understands everyone over the age of 18 who resides in the home must recieve a criminal record clearance. L1 will have A1 cleared and associated OR A1 must be removed from the facility. L1 will provide a written statement to LPA Melinda.mohr@dss.ca.gov within 24 hours.
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This was not met as evidenced by:
Based on interview with L1, L1 admitted (A1) been staying in the home since 06/2024 and has not received a criminal record clearance.
This poses an immediate 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: Leslie Lepori
LICENSING EVALUATOR NAME: Melinda Mohr
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4