493006543-2-25-2021-01-CC-AHON-BYL6WP-20210225201037

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 493006543
Report Date: 02/25/2021
Date Signed: 02/25/2021 01:51:51 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/11/2020 and conducted by Evaluator Jennifer Velasco

COMPLAINT CONTROL NUMBER: 01-CC-20200911140559

FACILITY NAME:	NORTH BAY CHILDREN'S CENTER - SCHOOL-AGE		FACILITY NUMBER:	493006543
ADMINISTRATOR:	KERSTIN BANDNER		FACILITY TYPE:	840
ADDRESS:	1001 CHERRY STREET		TELEPHONE:	(707) 763-6222
CITY:	PETALUMA	STATE: CA	ZIP CODE:	94952
CAPACITY:	42	CENSUS: 0	DATE:	02/25/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Debbie Neal		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Facility staff handle day care child(ren) in a rough manner.

INVESTIGATION FINDINGS:

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Due to the Covid-19 public health emergency, an announced tele-visit was conducted by Licensing Program Analyst Jennifer Velasco (LPA), who met with NBCC South County Area Director Debbie Neal (M1). This tele-visit was conducted with M1 at an offsite location due to facility’s temporary closure engendered by a staff’s offsite exposure to Covid-19. It was alleged that staff handled a child (C1) in a rough manner; specifically, staff grabbed a child by the arm. During the 09/15/2020 initial inspection tele-visit, LPA toured the facility remotely, conducted an interview with two adults (M1, D1), and obtained and reviewed pertinent facility documents. LPA interviewed one adult on 09/17/2020, one adult on 02/01/2021, and one adult on 02/05/2021. On 02/11/2021, LPA interviewed four children. On 02/22/2021, LPA interviewed one child and three adults. Documentation and witness statements corroborate the allegation that staff handled one or more children roughly. Based on interviews and facility documents, the preponderance of evidence standard has been met; therefore, the above allegation is found to be substantiated.

Continued on LIC 9099-C.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Jennifer Velasco	TELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2021

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-20200911140559

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: NORTH BAY CHILDREN'S CENTER - SCHOOL-AGE	FACILITY NUMBER: 493006543
	VISIT DATE: 02/25/2021

NARRATIVE

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Continued from LIC 9099

This report was reviewed and discussed with M1. M1’s original signature was not recorded on this report; however, M1 was provided with a copy of the LIC9099 Complaint Investigation Report (CIR) and Appeal Rights in an email dated 02/25/2021 and confirmation of read receipt of the CIR is on file. The following violation of the California Code of Regulation, Title 22, was cited: See attached LIC9099-D.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Jennifer Velasco	TELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 01-CC-20200911140559

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: NORTH BAY CHILDREN'S CENTER - SCHOOL-AGE	FACILITY NUMBER: 493006543
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/25/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed Type B 03/25/2021 Section Cited CCR 101223(a)(3)	1 2 3 4 5 6 7	Personal rights: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Area Director stated she will obtain and/or conduct staff training on trauma-informed care, personal rights, and classroom management, and will submit a detailed training agenda, attendance sheet, and written plan detailing how the facility plans to ensure all staff comply
	8 9 10 11 12 13 14	multiple witnesses statements that staff pulled/dragged children in care. This presents a potential health and safety risk to children in care.	8 9 10 11 12 13 14	with CCR 101223(a)(3) to LPA via email by 03/25/2021. LPA email: jennifer.velasco@dss.ca.gov
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	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Jennifer Velasco	TELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2021

LIC9099 (FAS) - (06/04)

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