490111249-7-1-2026-01-CC-MMOR-DVYNS5-20260714104233

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 490111249
Report Date: 07/01/2026
Date Signed: 07/01/2026 04:02:51 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
06/25/2026 and conducted by Evaluator Sebastian Phouthavong

PUBLIC

COMPLAINT CONTROL NUMBER: 01-CC-20260625152545

FACILITY NAME:	SAN MIGUEL EXTENDED CHILD CARE		FACILITY NUMBER:	490111249
ADMINISTRATOR:	JASON RIGGS		FACILITY TYPE:	840
ADDRESS:	5350 FAUGHT ROAD		TELEPHONE:	(707) 546-0667
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95403
CAPACITY:	182	CENSUS: 102	DATE:	07/01/2026
		UNANNOUNCED	TIME BEGAN:	01:31 PM
MET WITH:	Gen McDowell & Vanessa Ruiz		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Staff are operating out of ratio

INVESTIGATION FINDINGS:

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An unannounced complaint investigation was conducted at the facility by Licensing Program Analyst (LPA) Sebastian Phouthavong to investigate an allegation filed against the facility. Upon arrival, the LPA met with Site Supervisor 2, Gen McDowell (SS2), and later met with Site Supervisor 1, Vanessa Ruiz (SS1), to discuss the allegation. It is alleged that Staff are operating out of ratio.

During the course of the investigation, the Licensing Program Analyst (LPA) conducted interviews with Site Supervisor 1 (SS1), Site Supervisor 2 (SS2), and staff members (S1–S6). Based on LPA's observations, SS1 and two staff members (S6 and S7) were supervising 32 daycare children in Classroom AS2. LPA observed S6 leave the classroom for approximately 15 minutes, resulting in the classroom operating out of ratio during that period. Additionally, interviews with staff (S2 & S3) indicated that on a previous date, one staff member had supervised approximately 20 daycare children alone during staff transition periods.

Continued on LIC 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Melinda Mohr
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 01-CC-20260625152545

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: SAN MIGUEL EXTENDED CHILD CARE	FACILITY NUMBER: 490111249
	VISIT DATE: 07/01/2026

NARRATIVE

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Continued from LIC 9099.

Based on the information gathered during this investigation, the preponderance of the evidence standard has been met. Therefore, the allegation is determined to be substantiated. California Code of Regulations, Title 22, is being cited on the attached LIC 9099-D. Appeal rights were provided. An exit interview was conducted, and this report was read and discussed with the facility’s Supervisor 1, Vanessa Ruiz (SS1). The Notice of Site Visit shall be posted for 30 days.

SUPERVISORS NAME: Melinda Mohr
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2026

LIC9099 (FAS) - (06/04)

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Control Number 01-CC-20260625152545

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: SAN MIGUEL EXTENDED CHILD CARE	FACILITY NUMBER: 490111249
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/01/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type B 07/29/2026 Section Cited CCR 101516.5(b)	1 2 3 4 5 6 7	101516.5 (b) There shall be a staffing ratio of one teacher and one aide present to every 28 children in attendance. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Site Supervisor 1 was provided Regulation 101516.5 Teacher-Child Ratio and will provide the facility procedure on ratio and how it will ensure ratio requirements will be met. Site Supervisor 1 will submit of the procedure by 07/29/2026 to LPA's email: sebastian.phouthavong@dss.ca.gov
	8 9 10 11 12 13 14	Based on LPA's Based on LPA's observations, SS1 and S7 were supervising 32 daycare children in one classroom which poses a potential health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14
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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.

SUPERVISOR'S NAME: Melinda Mohr
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2026

LIC9099 (FAS) - (06/04)

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