493010889-6-25-2026-01-CC-MMOR-DVKLQX-20260701085817

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 493010889
Report Date: 06/25/2026
Date Signed: 06/25/2026 12:28:29 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
04/02/2026 and conducted by Evaluator Sebastian Phouthavong

COMPLAINT CONTROL NUMBER: 01-CC-20260402135733

FACILITY NAME:	JOHNSON, TIFFANY FAMILY CHILD CARE HOME		FACILITY NUMBER:	493010889
ADMINISTRATOR:	JOHNSON, TIFFANY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 393-1051
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95403
CAPACITY:	14	CENSUS: 5	DATE:	06/25/2026
		UNANNOUNCED	TIME BEGAN:	11:05 AM
MET WITH:	Tiffany Johnson		TIME COMPLETED:	11:29 AM

ALLEGATION(S):

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Licensee operates out of ratio
Staff pick up day care children by their hand
Licensee swaddles day care infants
Licensee restrains day care children

INVESTIGATION FINDINGS:

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A subsequent complaint investigation visit was conducted today by Licensing Program Analyst (LPAs), Sebastian Phouthavong and Ivet Zamora Perez who met with Licensee, Tiffany Johnson (LS) for the purpose of delivering complaint investigation finding for the above allegations. LPA, Sebastian Phouthavong previously conducted an inspection on 04/07/2026 to initiate the investigation and met with Licensee (LS) to discuss the allegations, conduct interview(s), make observations, and request documents. It is alleged Licensee operates out of ratio, staff pick up day care children by their hand, Licensee swaddles day care infants and finally that Licensee restrains day care children.

During the course of the investigation, LPA, Sebastian Phouthavong conducted interviews with the Licensee (LS), three staff (S1 – S3), one children (C1), and three parents (P1 – P3). Additionally, LPA attempted to interviews with two additional parents (P4 & P5) and one child (C2) between 04/07/2026 and 06/25/2026. LS denied the allegations and stated that there are always at least two staff members present at the facility, with additional staff available on standby if needed.
Continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Melinda Mohr
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2026

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-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: 06/25/2026

NARRATIVE

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Continued from LIC 9099.
Interviews with staff (S1–S3) indicated that there are always at least two staff members present at the facility and S2 further stated that additional staff are available as needed, corroborating LS's statement.

LS and Staff (S1 – S3) stated that they do not pick up children by force or physically restrain children as a form of discipline. LS and S1 stated that when children misbehave, staff redirect the children. LS and Staff (S1 & S2) further stated that children may be placed in time-out. Additionally, Staff (S2 & S3) stated that staff would discuss the child's behavior. LS also stated that staff may hold children's hands when requested by children or while participating in activities together. Furthermore, LS and S1 stated that children are not forced to nap and are allowed to do quiet activities in a separate room during nap time.

Interviews from LS and Staff (S2 & S3) stated that infants are not swaddled at the facility. However, LS stated that blankets are used to assist infants in falling asleep but are removed once the infants are asleep and transferred to appropriate sleep equipment. In addition, S1 stated that blankets are used to swaddle infants while they are being held and napping. Interviews conducted with Parents (P1 – P3) and one Child (C1) did not have any current concerns with the facility 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 Licensee, Tiffany Johnson (LS). 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: 06/25/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2026

LIC9099 (FAS) - (06/04)

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