483010241-8-30-2023-01-CC-LLEI-CV8RKS-20230831130601

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 483010241
Report Date: 08/30/2023
Date Signed: 08/30/2023 02:04:38 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
05/30/2023 and conducted by Evaluator Melchisedeck Augustin

PUBLIC

COMPLAINT CONTROL NUMBER: 01-CC-20230530165907

FACILITY NAME:	SEDIQI, MONISA FCCH		FACILITY NUMBER:	483010241
ADMINISTRATOR:	MONISA S & DEHYAR T		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 999-6699
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94534
CAPACITY:	14	CENSUS: 14	DATE:	08/30/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Monisa Sediqi		TIME COMPLETED:	09:30 AM

ALLEGATION(S):

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Licensee allowed an excluded adult to provide care and supervision to day-care children.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPAs), Melchisedeck Augustin and Selna Mariani made an unannounced complaint-investigation visit and met with Licensee, Monisa Sediqi (LS), for the purpose of delivering finding for the above allegation. LPAs previously met with LS on 06/01/23 to initiate the investigation by discussing the purpose of the visit, conducting interviews with LS and staff, making observations; and requested a facility roster of the children currently in care. It is alleged that the Licensee allowed an excluded adult to provide care and supervision to day-care children.

LPA Augustin interviewed LS, two staff (S1 & S2), one adult (A2) and five parents (P1-P5), from 06/01/23 through 08/24/23. LS denied claims about allowing an excluded adult to provide care and supervision to day-care children. According to LS, the excluded adult (A1) was related to LS and LS was aware that A1 was not allowed to enter the facility when children were present, however; sometimes LS allowed A1 to deliver items to the facility but A1 did not enter the home. (Continue to LIC 9099-C)

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

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 4

Control Number 01-CC-20230530165907

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: SEDIQI, MONISA FCCH	FACILITY NUMBER: 483010241
	VISIT DATE: 08/30/2023

NARRATIVE

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Furthermore, A1 transported her own children plus LS’s minor relatives to school, and during the facility’s non-operating hours, A1 visited the home to attend family events. The statements S1 & S2 provided indicated that A1 visited the facility to pick up and drop off LS’s minor relatives to school and A1 did not visit the facility during hours of operation.

Statement provided by three parents (P1-P3) confirmed they witnessed A1 providing care and supervision at the facility. P1 described when she dropped her child off one day in the morning of July 2023, she noticed A1 in the backyard doing water activity with the daycare children. P2 validated that A1 was the point of contact and on multiple occasions when he dropped his child off, A1 was waiting at the facility entry door to greet them, while P3 stated she dropped her child off on more than five occasions and saw A1 inside the facility; and P3 assumed A1 was staff. Department records indicated there was an existing Decision and Order which confirmed A1 was excluded from facilities licensed by the Department for two years, effective, 08/18/2022.

The facility did not comply with CCR 102370(d)(1) which requires all individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: obtain a California clearance or a criminal record exemption as required by the Department. An immediate $500 Civil Penalty is being assessed because LS did not ensure A1 obtained a criminal record clearance prior to working at the facility. LS was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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, Monisa Sediqi. The following violation of California Code of Regulations, Title 22, Division 12, was cited during today's visit. Appeal Rights were provided. (Continue to LIC 9099-C)

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

LIC9099 (FAS) - (06/04)

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Control Number 01-CC-20230530165907

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: SEDIQI, MONISA FCCH	FACILITY NUMBER: 483010241
	VISIT DATE: 08/30/2023

NARRATIVE

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LPA, Melchisedeck Augustin informed licensee, Monisa Sediqi that this report dated 08/30/2023 document(s) one Type A citation 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 08/30/2023 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: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 01-CC-20230530165907

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: SEDIQI, MONISA FCCH	FACILITY NUMBER: 483010241
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/30/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/30/2023 Section Cited CCR 102370(d)(1)	1 2 3 4 5 6 7	All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department	1 2 3 4 5 6 7	Licensee stated she would ensure all adults prior to residing or working at the facility, obtained a criminal record clearance. Licensee stated she also would not allow A1 to visit the facility during the facility's operating hours.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Based on statement provided by P1-P3 which confirmed they witnessed A1 providing care and supervision at the facility, & a $500 Civil Penalty is being assessed because LS didn't ensure A1 obtained a criminal record clearance prior to working at the facility.	8 9 10 11 12 13 14	A follow up inspection is required after 08/30/23 to verify that adults residing or working at the facility obtained a criminal record clearance.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

LIC9099 (FAS) - (06/04)

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