493006901-7-22-2026-01-CC-MMOR-DWHLUJ-20260731090402

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 493006901
Report Date: 07/22/2026
Date Signed: 07/22/2026 02:35:19 PM

Unsubstantiated

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
05/05/2026 and conducted by Evaluator Sebastian Phouthavong

PUBLIC

COMPLAINT CONTROL NUMBER: 01-CC-20260505111915

FACILITY NAME:	4CS WILLOW CREEK STATE PRESCHOOL		FACILITY NUMBER:	493006901
ADMINISTRATOR:	PATINO, OFELIA		FACILITY TYPE:	850
ADDRESS:	2536 MARLOW ROAD		TELEPHONE:	(707) 570-2607
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95403
CAPACITY:	32	CENSUS: 17	DATE:	07/22/2026
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Ofelia Patino		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Child sustained injuries due to staff neglect or physical abuse.
Staff did not meet the diapering needs of a daycare child.
Staff did not meet health related services for a daycare child.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

A subsequent complaint investigation visit was conducted today by Licensing Program Analyst (LPA), Sebastian Phouthavong, who met with Site Supervisor, Ofelia Patino (SS), for the purpose of delivering a complaint investigation finding for the above allegations. LPA previously conducted an inspection on 05/08/2026 to initiate the investigation and met with Site Supervisor to discuss the allegations, conduct interview(s), make observations, and request documents. It was alleged that a child sustained injuries due to staff neglect or physical abuse and that staff did not meet health related services for a daycare child. Specifically, that Child 1 (C1) sustained multiple injuries while in care and staff do not provide any medical treatment. It’s also alleged that staff did not meet the diapering needs of a daycare child specifically that C1 has been left in the same diaper for hours on multiple occasions.

During the course of the investigation, LPA conducted interviews with Site Supervisor (SS), Program Director, Jenny Copeland (PD), two staff (S1 – S2) & three parents (P1 – P3) and attempted six additional parent interviews from 05/08/2026 to 07/16/2026.
Continued on LIC9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Melinda Mohr
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026

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 2

Control Number 01-CC-20260505111915

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: 4CS WILLOW CREEK STATE PRESCHOOL	FACILITY NUMBER: 493006901
	VISIT DATE: 07/22/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Continued from LIC9099.
SS denied the allegations. SS and Staff (S1 & S2) stated on one of the alleged incidents, C1 fell on the table and that S1 checked on the C1 and applied an ice pack. In addition, S2 stated that an ouch report was created regarding the C1’s injury. SS also stated that it was alleged C1 sustained bruises while at the facility, however, SS was not notified of the bruises and could not confirm whether they occurred at the facility. No corroborating evidence was identified to determine whether C1 sustained the bruises while in care.

In addition, SS and Staff (S1 & S2) stated that the facility’s policy for responding to injuries is to assess the child, clean the injury, and provide appropriate first aid, such as applying an ice pack. SS and S1 further stated that an Ouch Report is created to document the injury and is provided to the child's parent. SS & Staff (S1 & S2) also stated that if the injury involved a child's head, the child’s parent would be immediately notified.

SS and Staff (S1 & S2) stated that C1 has a difficult time when changing their pull ups and that staff would attempt to encourage C1 to get changed. SS and S2 further stated that staff have C1 play with a toy to assist when getting changed. SS and S1 also stated that C1 is given additional time get their pull up changed. Additionally, SS stated that staff check C1's pull-up more frequently than those of the other children to help ensure C1's needs are addressed promptly.

SS and Staff (S1 & S2) stated that the facility's diapering policy is to check children's diapers throughout the day, including in the morning and before part-time children depart for the day. S1 also stated that children are regularly reminded to use the bathroom, and that staff make efforts to ensure that all children leave the facility with a clean diaper. Additionally, SS and Staff (S1 & S2) stated that that the facility maintains a diapering log to document diaper checks and changes. S1 did state that occasionally children’s diapers are full shortly before the children is picked up and parents would be asked if they request their child's diaper changed before getting released into their care. Interviews conducted with parents (P1 – P3) did not have any concerns with allegations at this time.

Based on the information gathered during this investigation, although the allegations 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. This report was reviewed and discussed with Site Supervisor, Ofelia Patino (SS). Appeal rights were provided. Notice of Site Visit shall be posted for 30 days from today's visit.

SUPERVISORS NAME: Melinda Mohr
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 2