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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 173010444
Report Date: 09/20/2024
Date Signed: 09/20/2024 12:49:54 PM

Unsubstantiated


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
07/15/2024 and conducted by Evaluator Sebastian Phouthavong
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20240715140622
FACILITY NAME:HERNANDEZ, NORMA FCCHFACILITY NUMBER:
173010444
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
09/20/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Norma HernandezTIME COMPLETED:
01:05 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee did not allow childs authorized representative entry to the facility.
Licensee allowed children to be without care and supervision.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
A subsequent complaint investigation visit was conducted today by Licensing Program Analyst (LPA), Sebastian Phouthavong who met with Licensee, Norma Hernandez for the purpose of delivering complaint investigation findings for the above allegations. LPA previously conducted an inspection on 07/15/2024 to initiate the investigation and met with Licensee to discuss the allegations, conduct interview(s), make observations, and request documents. LPA conducted further investigation while at the facility on 07/25/2024. It is alleged that Licensee did not allow child’s authorized representative entry to the facility. Also, Licensee allowed children to be without care and supervision specifically that children are allowed on be on the upper platform in front of the facility's entrance door unsupervised.

During the course of the investigation, LPA reviewed records and conducted interviews with the Licensee (LS), 3 Adults (A1 – A3) and 2 children (C3-C4) from 07/16/2024 to 09/17/2024. LS stated that daycare parents are allowed inside the facility at any time.
(Continued on LIC 809-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024
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 2
Control Number 01-CC-20240715140622
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: HERNANDEZ, NORMA FCCH
FACILITY NUMBER: 173010444
VISIT DATE: 09/20/2024
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
(Continued from LIC 809)

LS further stated that if an unfamiliar person arrives and provides proof of their identification showing they are an authorized representative, LS would allow them entry to the facility.



LS stated on the alleged incident when an unknown individual arrived requesting entry to the home LS declined the individual due to not providing identification and not previously seeing the individual or “not recognizing the individual” or being on the list of authorized representatives. LS also stated it was for the safely of the children. From further investigation, it was determined that the unknown individual was the child’s authorized representative, but no proof of identification or court order was submitted.
LS stated she allowed the older children to be on the upper platform in front of the facility's entrance door but always had the front door open to supervise them at all times while she and/or the assistant was inside. Furthermore, LS stated the children would be on the platform for roughly 30 minutes and the younger children were not allowed on the platform.

Interviews from Adults (A2 & A3) stated that they were allowed entry to the facility, with A3 stating to have done a walkthrough inside the home. Interviews conducted by children had no concerns with the facility at this time. But an interview from C2 stated that LS would have the front door open to supervise them when on the upper platform, corroborating LS's statement.

Based on the information gathered during this investigation, although the allegation 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 the Licensee, Norma Hernandez. 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: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2