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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 483010241
Report Date: 01/03/2024
Date Signed: 01/03/2024 01:41:49 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA 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
11/01/2023 and conducted by Evaluator Selena Mariani
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20231101161532
FACILITY NAME:SEDIQI, MONISA FCCHFACILITY NUMBER:
483010241
ADMINISTRATOR:MONISA S & DEHYAR TFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 999-6699
CITY:FAIRFIELDSTATE: CAZIP CODE:
94534
CAPACITY:14CENSUS: 11DATE:
01/03/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Monisa SediqiTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Uncleared adult is providing care to day care children.
INVESTIGATION FINDINGS:
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On 1/3/2024, Licensing Program Analyst (LPA) Selena Mariani made an unannounced subsequent complaint investigation inspection and met with Licensee (L1) Monisa Sediqi for the purpose of delivering complaint findings. LPA previously conducted an inspection on 11/07/2023 to initiate the investigation and met with L1 to discuss the allegation, conduct interview(s), make observations, and request documents.

It has been alleged that an uncleared adult is providing care to day care children, specifically that on a previous date an adult submitted an application referring to them being employed to the facility, but background clearance listed as “Invalid.” LPA conducted interviews with the Licensee (L1), Staff 1 (S1) on 11/7/23; Adult 2 (A2), 3 Parent (P1-P3) on 12/20/23 and attempted interviews with 2 Children (C1 & C2). L1 and S1 denied the allegation and stated they are the only ones providing care for the children. A2 stated that they named this facility as their employer for training reimbursement in anticipation of working there when background clearance is obtained. Statements from Parents had no concerns with the facility at this time, but P2 stated on a previous date heard an individual in the home but could not confirm the individual. Continue on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Selena Mariani
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024
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 2
Control Number 01-CC-20231101161532
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: SEDIQI, MONISA FCCH
FACILITY NUMBER: 483010241
VISIT DATE: 01/03/2024
NARRATIVE
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Continue from LIC9099

Furthermore, LPA received a copy of the application submitted for reimbursement indicating that the facility was named as their employer and did not observe A2 working in the facility on 11/07/23 and 01/03/24.

Based on the information gathered during this investigation, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations occurred and therefore are determined to be unsubstantiated.



There were no Title 22 deficiencies cited during today's inspection. This report was reviewed and discussed with Licensee, Monisa Sediqi. Appeal Rights were provided. Notice of Site Visit shall be posted for 30 days from today's visit. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Selena Mariani
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2