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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 483001979
Report Date: 05/15/2024
Date Signed: 05/15/2024 01:21:42 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
04/19/2024 and conducted by Evaluator Glenn Ouye
COMPLAINT CONTROL NUMBER: 01-CC-20240419165015
FACILITY NAME:SIMMONS, NINA FAMILY CHILD CARE HOMEFACILITY NUMBER:
483001979
ADMINISTRATOR:SIMMONS, NINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 557-1102
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY:14CENSUS: 8DATE:
05/15/2024
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Nina SimmonsTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Licensee blocked the exit with a large slab of wood preventing the door from opening easily
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Glenn Ouye through the course of the interviewing the licensee and observation that a piece of wodd was used behind the sliding section of the glass sliding door.
The licensee said that she does not have the wood in the sliding door to prevent the children from leaving but to prevent homeless individuals from entering her home. She said that she has had people try to enter her home that were homeless and the wood stopped them from entering. LPA observed the wood behind the sliding glass door at 8:45am when entering the home and the children were already present in the faclity. The wood in the sliding glass door is a violation of personal rights has it creates a potential personal rights risk to the children who want to exit from the facility.

Based on the visual observation and the licensee’s own admission on May 15, 2024 that the wood is placed behind the sliding glass door, 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. Appeal rights were provided. An exit interview was conducted, and this report was read and discussed with the licensee. The Notice of Site Visit shall be posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024
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-20240419165015
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: SIMMONS, NINA FAMILY CHILD CARE HOME
FACILITY NUMBER: 483001979
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/24/2024
Section Cited
CCR
102423(a)(2)
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Personal Rights-Each child receiving services from a family child care home shall have certain rights that shall not be waived...To receive safe, healthful, and comfortable accommodations, furnishings, and equipment
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Licensee agrees to provide a written statement not to use any obeject in the door which prevents a child from self opening the door. A copy of the statement shall be sent to CCLD by the PODC date to clear the deficiency.
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This requirement was not met as evidenced by observation on 5/15/23 and admission by licensee on 5/15/24 that the wood is placed behind the sliding glass door is a potential violation of the child's personal rights.
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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: Glenn Ouye
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024
LIC9099 (FAS) - (06/04)
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