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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 493010889
Report Date: 04/07/2026
Date Signed: 04/07/2026 02:09:16 PM

Substantiated


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
04/02/2026 and conducted by Evaluator Sebastian Phouthavong
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20260402135733
FACILITY NAME:JOHNSON, TIFFANY FAMILY CHILD CARE HOMEFACILITY NUMBER:
493010889
ADMINISTRATOR:JOHNSON, TIFFANYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 393-1051
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY:14CENSUS: 11DATE:
04/07/2026
UNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Tiffany JohnsonTIME COMPLETED:
02:20 PM
ALLEGATION(S):
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Licensee is not present in the facility eighty percent of the operating hours
INVESTIGATION FINDINGS:
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On 04/07/2026, an unannounced complaint investigation visit was made today by Licensing Program Analyst (LPA), Sebastian Phouthavong to investigate allegation filed against the facility. LPA met with Licensee, Tiffany Johnson (LS) to discuss the allegation, conduct interview(s), make observations, and request documents. It is alleged that Licensee is not present in the facility eighty percent of the operating hours.

During the course of the inspection, LPA conducted interviews with Licensee (LS) and one staff (S1). LS admitted they were absent from the facility for a entire operational day due to personal reasons. Licensee also stated that two staff members were present and providing care to the children during that time. An interview with Staff (S1) confirmed that there was a day when the Licensee was not present for the full operational day, corroborating the Licensee’s statement.
Continued on LIC9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Mohr
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2026
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 4
Control Number 01-CC-20260402135733
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: JOHNSON, TIFFANY FAMILY CHILD CARE HOME
FACILITY NUMBER: 493010889
VISIT DATE: 04/07/2026
NARRATIVE
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Continued from LIC9099.
Based on the information gathered during this investigation, the preponderance of the evidence standard has been met. Therefore, the allegation is determined to be substantiated. California Code of Regulations, Title 22, is being cited on the attached LIC 9099-D. Appeal rights were provided. An exit interview was conducted, and this report was read and discussed with the facility’s Licensee, Tiffany Johnson. The Notice of Site Visit shall be posted for 30 days.
SUPERVISORS NAME: Melinda Mohr
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 01-CC-20260402135733
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: JOHNSON, TIFFANY FAMILY CHILD CARE HOME
FACILITY NUMBER: 493010889
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/07/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/28/2026
Section Cited
CCR
102417(a)
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102417(a) Operation of a Family Child Care Home, The licensee shall be present in the home and shall ensure that children in care are supervised at all times..... Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.
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Licensee stated they will submit a statement on their understanding of the Temporary absence requirements. Licensee will email the statement to LPA at sebastian.phouthavong@dss.ca.gov by 04/28/2026.
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Based on interviews with LS & S1, Licensee was temporary absence more than 20 percent of the hours that the facility is providing care per day, which poses a potential health and safety risk 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: Melinda Mohr
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4