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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 493008329
Report Date: 08/02/2024
Date Signed: 08/02/2024 05:09:01 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
08/02/2024 and conducted by Evaluator Robert Maciel
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20240802153316
FACILITY NAME:HARTLEY, LISA FCCHFACILITY NUMBER:
493008329
ADMINISTRATOR:HARTLEY, LISAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 539-5028
CITY:SANTA ROSASTATE: CAZIP CODE:
95409
CAPACITY:14CENSUS: 7DATE:
08/02/2024
UNANNOUNCEDTIME BEGAN:
04:07 PM
MET WITH:Vivian Marcela Rocha PereiraTIME COMPLETED:
05:28 PM
ALLEGATION(S):
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Provider is not present 80% of the time.
INVESTIGATION FINDINGS:
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During an annual inspection on 8/2/24, CCL received a complaint alleging that the Licensee is not present in the home for 80% of hours of operation.
Upon arrival, Licensing Program Analyst (LPA) Robert Maciel observed that the Licensee (LS) was not present in the facility. Two assistants, Vivian Marcela Rocha Pereira (S1) and staff 2 (S2) were present and were supervising and caring for 7 children in the home. LPA interviewed S1, S2, and LS via telephone who confirmed the licensee had not been present in the home since 11:00 AM that day and would not return to the faciltiy until 8/5/24.

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. The Notice of Site Visit must be posted for 30 days. Continued on LIC9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024
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 3
Control Number 01-CC-20240802153316
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: HARTLEY, LISA FCCH
FACILITY NUMBER: 493008329
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/05/2024
Section Cited
CCR
102417(a)
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(a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.
This requirement is not met as evidenced by:
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Facility representative stated that the Licensee will need to be present 80% of the time and if she is not able to maintain that requirement, than the facility will close for the day.
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Based on observation and interview, the licensee was not present in the home at the time of the inspection and stated that she had left at 11:00 AM that morning and would not return that day, leaving two assistants, staff 1 (S1) and staff 2 (S2) to provide care and supervision which poses an immediate health, safety or personal rights risk to persons 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.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 01-CC-20240802153316
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: HARTLEY, LISA FCCH
FACILITY NUMBER: 493008329
VISIT DATE: 08/02/2024
NARRATIVE
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LPA informed Facility representative, Vivian Marcela Rocha Pereira, that this report dated 08/02/2024 documents one Type A citation. Type A citations which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

LPA informed the Facility representative to provide a copy of this licensing report dated 08/02/24 that documents any Type A citation 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: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3