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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 173008720
Report Date: 04/14/2023
Date Signed: 04/14/2023 11:14:48 AM

Substantiated


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
01/30/2023 and conducted by Evaluator Sebastian Phouthavong
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20230130115023
FACILITY NAME:MCBRAYER, MICHELLE FCCHFACILITY NUMBER:
173008720
ADMINISTRATOR:MCBRAYER, MICHELLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 994-9580
CITY:CLEARLAKESTATE: CAZIP CODE:
95422
CAPACITY:14CENSUS: 4DATE:
04/14/2023
UNANNOUNCEDTIME BEGAN:
10:31 AM
MET WITH:Michelle McBrayerTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Provider is caring for children alone without valid CPR/First Aid training.
INVESTIGATION FINDINGS:
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A subsequent complaint investigation visit was made today by Licensing Program Analyst (LPA), Sebastian Phouthavong who met with Licensee, Michelle McBrayer for the purpose of delivering complaint investigation findings for the above allegation. LPA, previously met with Licensee on 01/19/2023 and 03/27/2023 to initiate the investigation by discussing the allegation, conducting interview(s), making observations, and requesting documents.

It is alleged that a Provider is caring for day care children alone without a valid Pediatric CPR and First Aid Certification. Licensee denied the allegations and was currently in the process of completing the training. At today’s inspection, the facility was toured inside and out. There were four children being supervised Licensee at the facility during the time.

During the course of the investigation, LPAs conducted interviews with the Licensee, three staff, two adults, and four parents and reviewed records.
Continues on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023
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 01-CC-20230130115023
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: MCBRAYER, MICHELLE FCCH
FACILITY NUMBER: 173008720
VISIT DATE: 04/14/2023
NARRATIVE
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Continued from LIC9099
On 01/19/2023, S3 stated they did not have a current Pediatric CPR and First Aid Certification and there were times when they were alone with day care children while another staff member would pick up other day care children. In addition, statements from two Adults indicated that, on multiple occasions, they have known or observed a staff member without a current Pediatric CPR Certification was left alone with day care children. The allegation is further corroborated by another individual, A1 stating to have observed the same situation many years ago.

Based on the information gathered during this investigation, the preponderance of evidence standard has been met and 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, Michelle McBrayer. The Notice of Site Visit shall be posted for 30 days.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
01/30/2023 and conducted by Evaluator Sebastian Phouthavong
COMPLAINT CONTROL NUMBER: 01-CC-20230130115023

FACILITY NAME:MCBRAYER, MICHELLE FCCHFACILITY NUMBER:
173008720
ADMINISTRATOR:MCBRAYER, MICHELLEFACILITY TYPE:
810
ADDRESS:13731 LAKESHORETELEPHONE:
(707) 994-9580
CITY:CLEARLAKESTATE: CAZIP CODE:
95422
CAPACITY:14CENSUS: 4DATE:
04/14/2023
UNANNOUNCEDTIME BEGAN:
10:31 AM
MET WITH:Michelle McBrayerTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Licensee is not present in the home the required amount of time while the day care is operating.
INVESTIGATION FINDINGS:
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A subsequent complaint investigation visit was made today by Licensing Program Analyst (LPA), Sebastian Phouthavong who met with Licensee, Michelle McBrayer for the purpose of delivering complaint investigation findings for the above allegation. LPA, previously met with Licensee on 01/19/2023 and 03/27/2023 to initiate the investigation by discussing the allegation, conducting interview(s), making observations, and requesting documents.

Regulation requires that the Licensee’s temporary absence from the facility shall not exceed 20 percent of the operating hours. It is alleged the Licensee is not present in the home the required amount of time while the day care is operating. Licensee denied the allegation. At today’s inspection, the facility was toured inside and out. There were four children being supervised by Licensee at the facility during the time.
During the course of the investigation, LPAs conducted interviews with the Licensee, three staff, two adults, and four parents and reviewed records.
Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 01-CC-20230130115023
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: MCBRAYER, MICHELLE FCCH
FACILITY NUMBER: 173008720
VISIT DATE: 04/14/2023
NARRATIVE
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Licensee and S3 stated the Licensee is mostly present at the home and would occasionally take vacations. Records and statements from Licensee and Staff (S1 – S3) did confirm that the Licensee was gone from the time frame of 12/01/2022 to 12/05/2022 and 01/26/2023 to 01/29/2023, but that the facility was either closed or had staff members providing care when the facility was open. S3 stated that the Licensee does walk to the local school to pick up day care children but would be gone for short amount of time. Parent interviews stated to observe the Licensee at the home the majority of the time or would have at substitute staff member providing care if Licensee was not available. Parents did not have a concern with the allegation at this time and could not corroborate the allegation.

S3 stated there was a time when they were left alone with the children when another staff member was picking up day care children from school but that the Licensee was present in the home the majority of the time. Additional statements from one Adult (A1) stated on multiple occasions they have observed a staff member left alone with daycare children many years ago or that the Licensee would not be present in the home most of the time. Even thought there is clams of licensee absents from the facility, records and interviews could not provide enough at this time.

Based on the information gathered during this investigation, there is no conclusive evidence to show that the Licensee is absent from the facility 20 percent of the time. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegation. The allegation is determined to be unsubstantiated. There were no Title 22 deficiencies cited. This report was reviewed and discussed with the facility’s Licensee, Michelle McBrayer. 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: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 01-CC-20230130115023
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: MCBRAYER, MICHELLE FCCH
FACILITY NUMBER: 173008720
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/15/2023
Section Cited
CCR
102416(c)(b)
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102416(c)(b) A licensee of a large family day care home...ensure that at least one person who has a current certificate in pediatric first aid and pediatric cardiopulmonary resuscitation ... be available at all times when children are present at the facility....
This requirement was not met as evidenced by:
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Staff Member (S3) has corrected the deficiency and currently has a valid Pediatric CPR and First Aid Certification as of today. LPA received a copy of the certification.
POC has been Cleared
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Based on Record Review Licensee’s staff member (S3) did not have a current Pediatric CPR and First Aid Certification when they were alone with day care children, which 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: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5