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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 490111872
Report Date: 01/11/2024
Date Signed: 01/11/2024 02:20:48 PM

Substantiated


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
01/03/2024 and conducted by Evaluator Selena Mariani
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20240103150758
FACILITY NAME:WOOD-SHAW, JANET FCCHFACILITY NUMBER:
490111872
ADMINISTRATOR:WOOD-SHAW, JANET FCCHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 795-8568
CITY:SEBASTOPOLSTATE: CAZIP CODE:
95472
CAPACITY:14CENSUS: 0DATE:
01/11/2024
UNANNOUNCEDTIME BEGAN:
01:08 PM
MET WITH:Janet Wood-ShawTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Licensee yells at daycare children
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Selena Mariani made an unannounced complaint investigation visit and met with Licensee (L1), Janet Wood-Shaw. LPA met with L1 to initiate the investigation by discussing the purpose of the visit. LPA Mariani inteviewed L1 at 1:24 pm, in which, Licensee admitted to the alligation stating she did yell at 5 children (C1 - C5) on 01/03/2024 while at Kotate Park. LPA obtained facility roster of the children currently in care.

Based on the evidence obtained, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, (Title 22), is being cited on the attached LIC 9099D. Appeal rights were provided and exit interview conducted. 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.


Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Selena MarianiTELEPHONE: (916) 605-8974
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
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-20240103150758
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: WOOD-SHAW, JANET FCCH
FACILITY NUMBER: 490111872
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/11/2024
Section Cited
CCR
102423(a)(1)
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102423 Personal Rights (a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following:
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LPA Mariani provided Regulations 102423 Personal Right, Licensee acknowlged the Personal Rights Regulations, signed and dated a copy for LPA Mariani.
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(1) To be treated with dignity in his/her personal relationship with staff and other persons. This requirement is not met as evidenced by: Based on licensee's interview stating licensee did yell at children C1-C5 on 01/03/2024. This poses a potential health and safety risk to the children 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.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Selena MarianiTELEPHONE: (916) 605-8974
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2