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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 493010192
Report Date: 01/03/2025
Date Signed: 01/03/2025 05:18:36 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
01/02/2025 and conducted by Evaluator Melinda Mohr
COMPLAINT CONTROL NUMBER: 01-CC-20250102123846
FACILITY NAME:YWCA PRESCHOOL-FORESTVILLEFACILITY NUMBER:
493010192
ADMINISTRATOR:PALOMA ESCALANTE DE BURROWFACILITY TYPE:
850
ADDRESS:6321 HWY 116TELEPHONE:
(707) 887-2279
CITY:FORESTVILLESTATE: CAZIP CODE:
95436
CAPACITY:24CENSUS: 6DATE:
01/03/2025
UNANNOUNCEDTIME BEGAN:
01:57 PM
MET WITH:Paloma Escalante De BurrowTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Staff did not meet child(ren)'s toileting needs
Licensee did not provide a comfortable environment for children in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mindy Mohr made an unannounced complaint investigation visit today and met with Site Supervisor (S1) Paloma Escalante De Burrows regarding the above allegations. It is alleged staff did not meet child(ren) toileting needs and Licensee did not provide a comfortable environment for children in care specifically while using the restroom.
LPA Mohr conducted interviews with two staff (S1 & S2) and received documentation pertaining to the investigation.

Continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melinda Mohr
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2025
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 4
Control Number 01-CC-20250102123846
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: YWCA PRESCHOOL-FORESTVILLE
FACILITY NUMBER: 493010192
VISIT DATE: 01/03/2025
NARRATIVE
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Staff (S1 & S2) confirmed child (C1) was in the bathroom for approximately 45 minutes completely undressed with feces on their back side. Staff stated C1 did not want help while in the bathroom and they did not force C1 to get cleaned up and put clothes back on. S1 stated they had called C1’s guardian as they usually do when an incident like this occurs with C1 and was told the guardian was on their way. S1 stated they stayed in the bathroom with C1 while waiting for their guardian to arrive. Staff also confirmed the facilities protocol for children while in the bathroom; if a child asks for assistance staff will assist that child, if a child does not ask for assistance or refuses assistance staff will not assist the child.

In addition, staff both stated the door to the bathroom stays open at all times. Staff stated if a child is in diapers they are either changed on the changing table or they stand in the middle of the bathroom and change themselves, while standing on a paper towel. LPA observed the bathroom door and one window to be open and the bathroom to be cold in temperature. Staff agreed the bathroom is cold, especially in the winter as there are no heaters in the bathroom. During LPAs tour of the restroom, it was observed to have a changing table located immediately in front of the door up against a toilet stall wall, two toilets each in their own stall, and one sink located in the corner of the bathroom. The bathroom is located right outside the preschool classroom door in an open hallway which is located on a elementary campus playground. When walking by the bathroom most of the inside of the bathroom is visible, specifically the changing table and the area of the bathroom children use while being changed.

Title 22, Division 12 Chapter 1, Regulation 101229(a)-Responsibility for Providing Care and Supervision requires that “the licensee shall provide care and supervision as necessary to meet the children’s needs” and according to Regulation 101152(c)(3)(A)-Care and Supervision is defined as “any one or more of the following activities provided by a person or child care center to meet the needs of children in care: Assistance in diapering, toileting, dressing, grooming, bathing and other personal hygiene.”

Continued on LIC9099-C

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melinda Mohr
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 01-CC-20250102123846
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: YWCA PRESCHOOL-FORESTVILLE
FACILITY NUMBER: 493010192
VISIT DATE: 01/03/2025
NARRATIVE
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Evidence identified C1’s need for assistance in the bathroom and staff did not assist C1 as staff are not comfortable assisting if C1 does not ask or accept assistance when offered. As such, the child’s needs were not met. Based on the investigation, the preponderance of evidence standard has been met. Therefore, the above allegations are found to be substantiated. The following violations of the California Code of Regulations, Title 22; Division 12: see LIC 9099D.

Exit interview was conducted, and report reviewed with Site Supervisor Paloma Escalante De Burrow.

Appeal rights were provided. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

LPA Mohr informed Site Supervisor, Paloma Escalante De Burrow that this report dated 01/03/2025 documents one Type A citation. Type A citations 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 Mohr informed Site Supervisor to provide a copy of this licensing report dated 01/03/2025 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: Leslie Lepori
LICENSING EVALUATOR NAME: Melinda Mohr
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 01-CC-20250102123846
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: YWCA PRESCHOOL-FORESTVILLE
FACILITY NUMBER: 493010192
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/06/2025
Section Cited
CCR
101229(a)
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(a) The licensee shall provide care and supervision as necessary to meet the children's needs.

This was not me as evidenced by:
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S1 stated she will make sure a child is offered a blanket, towel or something to cover up to stay warm. S1 stated they will always have 2 staff to support a child with meeting their needs.
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Based on staff interviews C1 was without clothes and was not properly cleaned for approximately 45 minutes. This posed an immediate health and safety risk to children in care.
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S1 will send LPA the plan to staff and assist children in the bathroom when necessary to Melinda.mohr@dss.ca.gov
Type B
01/31/2025
Section Cited
CCR
101223(a)(2)
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(a) The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
This was not me as evidenced by:
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S1 stated she will look into having the changing table moved to a different location not in front of the door and /or a smaller changing table purchased. S1 will email LPA a picture of the new location of the changing table at Melinda.mohr@dss.ca.gov
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Based on staff interview C1 was not provided comfortable accommodations as the bathroom was cold and C1 did not have privacy while being changed.
This poses/posed a potential health, safety and/or personal rights risk(s) to 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.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melinda Mohr
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4