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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 483003054
Report Date: 01/05/2024
Date Signed: 01/08/2024 11:09:20 AM

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
10/04/2023 and conducted by Evaluator Melchisedeck Augustin
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20231004092356
FACILITY NAME:STOVALL, CINDY FAMILY CHILD CARE HOMEFACILITY NUMBER:
483003054
ADMINISTRATOR:STOVALL, CINDYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 448-8775
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY:14CENSUS: 7DATE:
01/05/2024
UNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Cindy Stovall - LicenseeTIME COMPLETED:
09:45 AM
ALLEGATION(S):
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Licensee is not present in the home a sufficient amount of time while the day care is operating
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Melchisedeck Augustin made an unannounced Complaint-Investigation visit and met with Licensee (LS), Cindy Stovall, for the purpose of delivering finding for the allegation mentioned above. LPA previously met with LS on 10/13/23 to initiate the investigation by discussing the purpose of the visit, conducting an interview with LS, staff, and children; and obtained a facility roster of the children in care. It is alleged that the Licensee is not present in the home a sufficient amount of time while the day care is operating. The report noted LS left the home every other week, leaving a staff (S1) alone to provide care and supervision for the children for 12 to 14 hours.

LPA interviewed LS, two staff (S1-S2), four children (C1, C3-C5), four parents (P1-P4), and three adults (A1-A3), starting on 10/12/23 through 01/08/24. Some children were not verbal, too young to interview, or did not qualify to be interviewed. The allegation was substantiated when LS confirmed that on occasions, she was absent for a whole day during the facility’s operating hours from 6:30am to 5:30pm, Mon to Fri; and in her temporary absence, she left staff including S1 to provide care and supervision to the children.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024
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 5
Control Number 01-CC-20231004092356
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: STOVALL, CINDY FAMILY CHILD CARE HOME
FACILITY NUMBER: 483003054
VISIT DATE: 01/05/2024
NARRATIVE
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LS stated the facility was her primary residence, however; she sometimes left the facility on a Thursday and returned the next day, but most of the time, she left the facility at the beginning of the weekend and returned at the end of the weekend. Based on LS’s statement, she did not comply with California Code of Regulations (CCR) 102417(a) which indicates LS’s temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

Furthermore, multiple children’s statements reported LS sometimes left the facility and did not return on the same day, and in LS’s absence, S1 worked with the children. Based on the investigation, the preponderance of evidence standard has been met and therefore, the above allegation is found to be SUBSTANTIATED. 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. The following violation of the California Code of Regulations, Title 22, Division 12 was cited during this visit. Appeal Rights were provided.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
10/04/2023 and conducted by Evaluator Melchisedeck Augustin
COMPLAINT CONTROL NUMBER: 01-CC-20231004092356

FACILITY NAME:STOVALL, CINDY FAMILY CHILD CARE HOMEFACILITY NUMBER:
483003054
ADMINISTRATOR:STOVALL, CINDYFACILITY TYPE:
810
ADDRESS:907 MOONSTONE COURTTELEPHONE:
(707) 448-8775
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY:12CENSUS: 7DATE:
01/05/2024
UNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Cindy Stovall - LicenseeTIME COMPLETED:
09:45 AM
ALLEGATION(S):
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Staff are caring for children alone without valid CPR/First Aid training
Staff yell at day care children
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Melchisedeck Augustin made an unannounced Complaint-Investigation visit and met with Licensee (LS), Cindy Stovall, to deliver findings for the allegations mentioned above. LPA previously met with LS on 10/13/23 to initiate the investigation by discussing the purpose of the visit, conducting an interview with LS, staff, and children; and obtained a facility roster of the children in care. It is alleged that staff are caring for children alone without valid CPR/First Aid training and staff yell at day care children. The report noted one and half year ago, a staff (S1) that was not certified in pediatric cardiopulmonary Resuscitation and First Aid was left alone with the children every other week.

LPA interviewed LS, two staff (S1-S2), four children (C1, C3-C5), four parents (P1-P4), and three adults (A1-A3), starting on 10/12/23 through 01/08/24. Some children were not verbal, too young to interview, or did not qualify to be interviewed. LS denied claims about allowing staff without a current pediatric CPR/First Aid training to work alone with the children. (Continue to LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 01-CC-20231004092356
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: STOVALL, CINDY FAMILY CHILD CARE HOME
FACILITY NUMBER: 483003054
VISIT DATE: 01/05/2024
NARRATIVE
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Furthermore, LS denied staff yell at the children and stated, there was always a staff present that possessed current CPR/First Aid training, and to her knowledge, staff did not yell at or hit the children. According to LS, the facility’s discipline policy consisted of placing children in time out, and talking to the children, and LS did not report any prior or recent incident(s) related to staff misconduct. (Continue to LIC 9099-C)

Statements provided by children, S1, A2, and parents did not report any concerns related to LS leaving unqualified staff to care for children, witnessing staff yelling at children, and/or misconduct of staff. Although several statements did not report concerns, two statements claimed they heard staff yell loudly at or use inappropriate language to humiliate children, while another statement alleged, they witnessed S1 use her hand to hit a child on the right knee in the family room, however; those claims were not corroborated. A3 stated in the summer of 2023, A3 witnessed S1 smack a child in the back of the head because the child was not moving fast enough. S1 denied claims about violating children’s personal rights, and stated she did not yell or hit any child(ren) in care; and acknowledged it was her duty to report suspected child abuse to the proper authorities. Parents reported when they dropped their child(ren) off, they did not enter the home and parents could not confirm which staff were working or if they possessed current or valid CPR/First Aid training. Parents noted as they approached or walked away from the facility, they never heard staff yell, hit or be aggressive; and parents reported their child(ren) never disclosed anything concerning to them.

On 10/13/23, LPA observed LS and S1 providing care and supervision for 10 children, and at that time, LS furnished current copies of pediatric CPR/First Aid for herself and S1. Additionally, LPA did not observe any violations of children’s personal rights. Based on the investigation, there was no conclusive evidence to support the allegations. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. 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. There were no violation(s) of California Code of Regulations, Title 22, Division 12 cited at this time. Appeal Rights were provided.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 01-CC-20231004092356
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: STOVALL, CINDY FAMILY CHILD CARE HOME
FACILITY NUMBER: 483003054
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/15/2024
Section Cited
CCR
102417(a)
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The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the
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Licensee stated she now understood the CCR 102417(a) and she would ensure she placed mechanism in place to comply with the regulation. Licensee agreed to produce a written statement detailing how she intends to comply with CCR 102417(a).
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hours that the facility is providing care per day.

This requirement was not met as evidenced by: Based on the Licensee's statement which confirmed LS’s temporary absences exceeded 20 percent of the hours that the facility is providing care per day. This poses/posed a potential health, safety and/or personal rights risk to children in care.
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Email: melchisedeck.augustin@dss.ca.gov
Fax: 707-588-5080
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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: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5