493010314-12-7-2023-01-CC-LLEI-CYMSJJ-20231218125510

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 493010314
Report Date: 12/07/2023
Date Signed: 12/07/2023 01:38:53 PM

Unsubstantiated

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
11/17/2023 and conducted by Evaluator Sebastian Phouthavong

PUBLIC

COMPLAINT CONTROL NUMBER: 01-CC-20231117143547

FACILITY NAME:	MT. TAYLOR CHILDREN'S CENTER THREE		FACILITY NUMBER:	493010314
ADMINISTRATOR:	ELHRS, JULIE		FACILITY TYPE:	850
ADDRESS:	812 VINEYARD CREEK DRIVE		TELEPHONE:	(707) 526-3008
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95403
CAPACITY:	30	CENSUS: 21	DATE:	12/07/2023
		UNANNOUNCED	TIME BEGAN:	12:31 PM
MET WITH:	Director, Karen Guerin & Varla Dura		TIME COMPLETED:	01:40 PM

ALLEGATION(S):

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Staff did not inform authorized representative of incident timely

INVESTIGATION FINDINGS:

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A subsequent complaint investigation visit was conducted today by Licensing Program Analyst (LPA), Sebastian Phouthavong who met with Licensee, Varla Dura & Director, Karen Guerin for the purpose of delivering complaint investigation findings for the above allegations. LPA previously conducted an inspection on 11/20/2023 to initiate the investigation and met with Director, Karen Guerin to discuss the allegations, conduct interview(s), make observations, and request documents. It is alleged that Staff did not inform authorized representative of incident timely, specifically that an authorized representative was not reported timely on an incident that happened in October.

During the course of the investigation, LPA conducted interviews with the Director, 3 staff members (S1, S4, S5) & 5 Parents (P1-P5) from 11/20/2023 to 12/05/2023. D1 stated the facility would send a text message or call children’s representatives of any incident as soon as possible. D1 claimed to have notified the authorized representative but cannot recall informing them of the incident involved
(Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

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-20231117143547

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: MT. TAYLOR CHILDREN'S CENTER THREE	FACILITY NUMBER: 493010314
	VISIT DATE: 12/07/2023

NARRATIVE

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Interviews from S4 & S5 indicated an incident involving a child did occur, but the child did not show signs of an injury. Furthermore, S5 stated they assessed the child and offered first aid. S5 further stated they notified the authorized representative the following day. Parent interviews (P1-P5) indicated that notifications of any incidents have been received. In addition, P4 and P5 stated they have been received the day of the incident.

From the investigation, it has been determined the authorized representative was notified of the incident the following day of occurring, but the timeframe of when reported could not be verified. According to California Code of Regulations Observation of the Child 101226.3, staff shall report any incident to the child’s authorized representative but the timeframe when to be reported is not specified. It could not be confirmed when the incident was reported and what is considered timely.

Based on the information gathered during this investigation, although the allegation 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 the facility’s Licensee, Varla Dura & Director, Karen Guerin Appeal rights were provided. Notice of Site Visit shall be posted for 30 days from today's visit.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

LIC9099 (FAS) - (06/04)

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