<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 173010039
Report Date: 10/04/2022
Date Signed: 10/04/2022 02:45:34 PM

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
09/29/2022 and conducted by Evaluator Sebastian Phouthavong
COMPLAINT CONTROL NUMBER: 01-CC-20220929162408
FACILITY NAME:HANSON, SARA FCCHFACILITY NUMBER:
173010039
ADMINISTRATOR:HANSON, SARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 245-5225
CITY:KELSEYVILLESTATE: CAZIP CODE:
95451
CAPACITY:14CENSUS: 30DATE:
10/04/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Sara HansonTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee is absent more than 20 percent of the hours child care is open.

Child care facility is operating over capacity.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/04/2022, an unannounced complaint investigation visit was made today by Licensing Program Analyst (LPA), Sebastian Phouthavong to investigate allegations filed against the facility. Licensee is absent more than 20 percent of the hours childcare is open. Specifically, that the licensee would leave the property to take her own children to sports. It was also was alleged that Childcare facility is operating over capacity. Specifically, that the Licensee was providing care to 30 children at one time. The LPA met the Licensee, Sara Hanson and spoke with her regarding the complaint investigation. LPAs toured the facility inside and out, conducted interviews and requested facility documents.

During today's inspection, LPA observed, 12 children under the Licensee’s Family Child Care Home and 18 children under the 4H organization being supervised by three staff members. Overall brought the total capacity to 30 children. Licensee stated she is part of the 4H program and is the leader of the Beef Group. Licensee stated the 4H children receive care once a month from 11:00am to 2:00pm, doing activities including caring for the farm animals and garden. 4H children’s statement corroborates with the Licensee’s interview.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022
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-20220929162408
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: HANSON, SARA FCCH
FACILITY NUMBER: 173010039
VISIT DATE: 10/04/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The Licensee admitted she is providing care for more than 14 children at once. Licensee stated she leaves the premise Monday through Thursday, 2:00pm to 6:00pm to drop off children and coaches a children’s soccer team. The Licensee is not present for 80% of the time.

Based on the information gathered during this investigation, there is a preponderance of evidence to support the allegations. The allegation is determined to be SUBSTANTIATED. The following violation of the California Code of Regulations, Title 22; Division 12, was observed: see LIC 9099-D.

Exit interview conducted and report was reviewed with the Licensee, Sara Hanson and staff member, Jaylee Ison.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Appeal Rights were provided.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 01-CC-20220929162408
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: HANSON, SARA FCCH
FACILITY NUMBER: 173010039
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/05/2022
Section Cited
CCR
102416.5(a)
1
2
3
4
5
6
7
102416.5(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee stated she understand the regulation and will not provide care for more than 14 children at one time. Licensee stated she will document and submit a plan ensuring to meet CCL Requirements by 10/05/2022
Emailed to sebastian.phouthavong@dss.ca.gov
8
9
10
11
12
13
14
Based on observation and interviews, Licensee was operating above the licensed capacity of 14, which poses an immediate health and safety risk to the children in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 01-CC-20220929162408
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: HANSON, SARA FCCH
FACILITY NUMBER: 173010039
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/18/2022
Section Cited
CCR
102417(a)
1
2
3
4
5
6
7
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.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee stated she will she will document and submit a plan ensuring to not be temporary absence for more than 20% & meet CCL Requirements by 10/18/2022
Emailed to sebastian.phouthavong@dss.ca.gov
8
9
10
11
12
13
14
Based on observation and interviews, Licensee was temporary absence more than 20 percent of the hours that the facility is providing care per day, which poses an immediate health and safety risk to the children in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4