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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 483010013
Report Date: 01/15/2026
Date Signed: 01/15/2026 02:12:29 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC 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
12/18/2025 and conducted by Evaluator Selena Mariani
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20251218163026
FACILITY NAME:LITTLE BLESSINGS DAYCARE-INFANTFACILITY NUMBER:
483010013
ADMINISTRATOR:BUI, VANFACILITY TYPE:
830
ADDRESS:717 KENTUCKY STREETTELEPHONE:
(707) 720-9706
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:7CENSUS: 5DATE:
01/15/2026
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Van BuiTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff do not follow reporting requirements
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Selena Mariani and Jamie Clark made an unannounced complaint investigation visit today and met with Center Director (CD) Van Bui for the purpose of delivering findings for the above allegation. It was alleged that Staff do not follow reporting requirements, specifically that staff observed child (C1) injury upon arrival to daycare on December 1, 2025 and daycare had opportunities to report child (C1’s) injury on both December 1 and December 3, 2025. LPAs Selena Mariani and Dianne Morrison previously met with CD on December 22, 2025, to discuss the purpose of the visit, obtained documents, made observations and conducted staff interviews with CD and 2 staff (S1-S2).

During the investigation, CD admitted not reporting C1’s injury, although off work on December 1, 2025, the Center Director covering the facility on December 1, 2025, and staff (S1-S2) did not provide verbal notification or submit a written report to the department and appropriate agencies within 7 days.
(continued on LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melchisedeck Augustin
LICENSING EVALUATOR NAME: Selena Mariani
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
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-20251218163026
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: LITTLE BLESSINGS DAYCARE-INFANT
FACILITY NUMBER: 483010013
VISIT DATE: 01/15/2026
NARRATIVE
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Continue from LIC9099

C1’s injury was not reported to the Department by telephone or fax within the Department’s next working day and during business hours as required. The facility violated California Code of Regulations (CCR) 101212(d)(1)(D) which required the facility to notify the Department of Any suspected physical or psychological abuse of any child.

Therefore, based on the investigation, the preponderance of evidence standard has been met. The above allegation is found to be substantiated. The following violations of the Health and Safety Code section 1596.895; see LIC 9099D. Appeal rights were provided.

Exit interview was conducted, and report reviewed with Center Director, Van Bui.
SUPERVISORS NAME: Melchisedeck Augustin
LICENSING EVALUATOR NAME: Selena Mariani
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 01-CC-20251218163026
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: LITTLE BLESSINGS DAYCARE-INFANT
FACILITY NUMBER: 483010013
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/15/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/29/2026
Section Cited
CCR
101212(d)(1)(D)
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101212(d)(1)(D)....a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event....Any suspected physical or psychological abuse of any child. This requirement is not met as evidenced by:
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CD was provided the Regulation 101212 and will ensure to discuss the requirements with all staff and train staff on how to fill out unuaual incidnet report. CD stated she will email LPA proof of completion with all staff’s names printed with signatures and dated when discussed. The document will be emailed to LPA selena.mariani@dss.ca.gov by January 29, 2026
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Based on record review CD and staff interviews, a written report was not submitted to the department and appropriate agencies within 7 days, which poses a potential health, safety or personal rights risk to persons 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: Melchisedeck Augustin
LICENSING EVALUATOR NAME: Selena Mariani
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
LIC9099 (FAS) - (06/04)
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