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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073408850
Report Date: 10/21/2021
Date Signed: 10/21/2021 03:17:31 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/21/2021 and conducted by Evaluator Michelle Sutton
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20210521163443
FACILITY NAME:CANNADA, NICOLEFACILITY NUMBER:
073408850
ADMINISTRATOR:CANNADA, NICOLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 325-5993
CITY:BAY POINTSTATE: CAZIP CODE:
94565
CAPACITY:14CENSUS: 2DATE:
10/21/2021
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Nicole CannadaTIME COMPLETED:
03:20 PM
ALLEGATION(S):
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Individual living in the home poses a potential threat to children in care
INVESTIGATION FINDINGS:
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On 10/21/21 Licensing Program Analyst (LPA) Michelle Sutton met with licensee Nicole Cannada to deliver the findings of the above listed allegation. The complaint investigation was conducted by Special Investigator, Jorge Martinez of the Bureau of Investigations. During the course of the investigation interviews were conducted and records were reviewed. It was confirmed that Zachary Cobb, son of Nicole Cannada had molested 3 minor children. The actions against his family members occurred between the years of 2012-2013. During that time Licensee did not have a license. Based on the interviews which were conducted and record review(s), the preponderance of evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED. California Health and Safety Code 1568.092(a)(2), are being cited on the attached LIC 9099D.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
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 5
Control Number 02-CC-20210521163443
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: CANNADA, NICOLE
FACILITY NUMBER: 073408850
VISIT DATE: 10/21/2021
NARRATIVE
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Due to the issuance of a Type A Citation during today's inspection, a copy of this Licensing Report must be POSTED in the facility and PROVIDED to each existing parent by the end of today or next day child is in care. Report also must be PROVIDED to the parent of children who are enrolled over the next 12 months. In addition, a copy of the LIC 9224 Acknowledgement of Receipt of Licensing Reports must be signed by each parent and kept in each child's file.

An exit interview was conducted, where this report, the deficiency and plan of correction were discussed with Nicole Cannada. Licensee was provided a copy of their appeal rights (LIC 9058 12/15) and the signature on this form acknowledges receipt of these rights.

A NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED 30 DAYS
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 02-CC-20210521163443
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CANNADA, NICOLE
FACILITY NUMBER: 073408850
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/21/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/22/2021
Section Cited
HSC
1568.092(a)(2)
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1568.092 Officers, directors and employees of licensed facility; prohibited persons; removal; appeal (a) The department may prohibit any person from being a licensee [...], (2) Engaged in conduct[....].This requirement is not met as evidence by;
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Immediately, licensee son can’t be present in the home during day care hours and Licensee is informed that administrative action is being taken against her license.
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Based interviews and record reviews, licensee confirmed that son Zachary Cobb had molested 3 minor children family members. The actions of Zachary Cobb occurred between the years of 2012-2013. This is an immediate risk to Health and Safety or Personal Rights risk to persons 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: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/21/2021 and conducted by Evaluator Michelle Sutton
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20210521163443

FACILITY NAME:CANNADA, NICOLEFACILITY NUMBER:
073408850
ADMINISTRATOR:CANNADA, NICOLEFACILITY TYPE:
810
ADDRESS:74 YUBA CT.TELEPHONE:
(925) 325-5993
CITY:BAY POINTSTATE: CAZIP CODE:
94565
CAPACITY:10CENSUS: 2DATE:
10/21/2021
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Nicole CannadaTIME COMPLETED:
03:20 PM
ALLEGATION(S):
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Licensee did not report incident to appropriate parties
INVESTIGATION FINDINGS:
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On 10/21/21 Licensing Program Analyst (LPA) Michelle Sutton met with licensee Nicole Cannada to deliver the findings of the above listed allegation. The complaint investigation was conducted by Special Investigator, Jorge Martinez of the Bureau of Investigations. During the course of the investigation, interviews were conducted and records were reviewed. LICENSEE FAILED TO REPORT SEXUAL ABUSE BY ASSISTANT/SON ZACHARY COBB OF CHILDREN. Based on the interviews which were conducted and record review(s), the preponderance of evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter Number 102416.2), are being cited on the attached LIC 9099D.

Exit interview was conducted with Nicole Cannada, where this report, the deficiency and plan of correction were discussed. A NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED 30 DAYS AND APPEAL RIGHTS WERE
GIVEN.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 02-CC-20210521163443
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CANNADA, NICOLE
FACILITY NUMBER: 073408850
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/21/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/28/2021
Section Cited
CCR
102416.2(b)
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102416.2 Reporting Requirements (b) The licensee shall report to the Department any of the events [...] that occur during the operation of the family child care home. This requirement is not met as evidence by;
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Licensee will submit an Incident Report (LIC624). Licensee will send a written plan and statement understanding the reporting requirements and how she will ensure compliance with this regulation.

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Based on interviews and record reviews, licensee confirmed not reporting sexual abuse by assistant/son Zachary Cobb of children to CCLD. This poses a potential health, safety or personal rights risk to persons 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: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5