483009888-2-15-2023-01-CC-LLEI-CP4VCN-20230216151923

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 483009888
Report Date: 02/15/2023
Date Signed: 02/15/2023 05:16:18 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
11/22/2022 and conducted by Evaluator Melchisedeck Augustin

PUBLIC

COMPLAINT CONTROL NUMBER: 01-CC-20221122131052

FACILITY NAME:	REED, KYWANNA FCCH		FACILITY NUMBER:	483009888
ADMINISTRATOR:	REED, KYWANNA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 654-8563
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94590
CAPACITY:	14	CENSUS: 10	DATE:	02/15/2023
		UNANNOUNCED	TIME BEGAN:	04:30 PM
MET WITH:	Darion Winston - Facility Representative		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Child sustained injuries while in care due to inadequate supervision

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Melchisedeck Augustin made a subsequent complaint-investigation visit and met with Licensee, Kywanna Reed (LS) for the purpose of delivering finding for the above allegation. LPA previously met with LS on 11/23/22 to initiate the investigation by discussing the purpose of the visit, conducting interviews with LS and staff, making observations; and requesting a facility roster of the children currently in care. It was alleged that a child (C1) sustained injuries while in care due to inadequate supervision. Records show that C1 had visible lacerations and scratch marks on the right and left cheek and near or around the orbital areas, and visible laceration above the right eyebrow.

LPA, Augustin interviewed LS and two staff (S1 & S2), one parent (P1) from 11/23/22 through 02/08/23. Some children were not verbal, too young to interview, or did not qualify to be interviewed. LS confirmed C1 sustained the injuries due to inadequate supervision when LS stated on 11/17/22 at 5:28pm, she was the only staff present and sitting on a brown chair in the family room while C1 was in a low to the ground rocking chair, children (C3 & C4) were playing in the family room, and one child (C2) was in the backyard riding a bike. (Continue to LIC 9099-C)

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023

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 3

Control Number 01-CC-20221122131052

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: REED, KYWANNA FCCH	FACILITY NUMBER: 483009888
	VISIT DATE: 02/15/2023

NARRATIVE

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According to LS, C3 was near and crouching about one and half feet from C1 when C1’s cry prompted LS to go to the kitchen to prepare a bottle for C1. LS claimed that while she was in the kitchen pacing back and forth, she heard C1 cry. LS returned to the family room and saw C1 had been scratched on the left side of the face by C3. LS described the injuries as bleeding with broken skin in four separate areas and LS saw a little bit of blood on C3’s hand. LS stated that she felt this incident occurred as partial negligence on her part.

Statements provided by S1 & S2 confirmed they were not present on the day of incident and did not have information related to the isolated incident. During LPA’s unannounced visit on 11/23/22, LPA took a tour of the on limits areas which includes the family room, kitchen, and backyard. LPA noticed there was a large window with blind shade installed that was rolled all the way up to allow for visibility into the backyard, however; the serving hatch or opening in the wall between the kitchen and family room had objects such as a blender, small cooking equipment/appliances, and top ware that partially blocked or obstructed the view into the family room resulting in limited visibility which did not allow for LPA to see the position of C1’s low to the ground rocking chair; or the backyard. Based on LS’s statement and LPA’s observations on 11/23/22, there is enough evidence to determine that C1 sustained the injuries due to inadequate supervision, and as such, an immediate $500 Civil Penalty is being assessed due to the severity of C1’s injuries resulting from a lack of supervision.

A 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. Exit interview conducted and report was reviewed with the licensee, Kywanna Reed. LPA Melchisedeck Augustin informed licensee, Kywanna Reed that this report dated 02/15/2023 document(s) one Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA, Melchisedeck Augustin informed the licensee to provide a copy of this licensing report dated 02/15/2023 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.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023

LIC9099 (FAS) - (06/04)

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Control Number 01-CC-20221122131052

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: REED, KYWANNA FCCH	FACILITY NUMBER: 483009888
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/15/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/16/2023 Section Cited HSC 1596.99(c)(1)	1 2 3 4 5 6 7	The department shall assess an immediate civil penalty of five hundred dollars ($500) per violation and one hundred dollars ($100) for each day the violation continues after citation, for any of the following serious violations: Any violation that the department determines resulted in the injury or illness of a child.	1 2 3 4 5 6 7	Licensee stated she would remove the items on the serving hatch shelf between the kitchen and the family room and Licensee staed she would produce a written plan detailing how she would ensure a safer environment for the children in care. Licensee stated she intends to submit her written plan by 02/16/23 via email or fax.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based on LS’s statement confirming C1 sustained the injuries due to inadequate supervision, and as such, an immediate $500 Civil Penalty is being assessed due to the severity of C1’s injuries resulting from a lack of supervision. This poses an immediate health and safety risk to the children in care.	8 9 10 11 12 13 14	Email: melchisedeck.augustin@dss.ca.gov Fax: 707-588-5099
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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: 02/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023

LIC9099 (FAS) - (06/04)

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