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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 173010786
Report Date: 07/18/2025
Date Signed: 07/29/2025 01:14:06 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
07/17/2025 and conducted by Evaluator Sebastian Phouthavong
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20250717155029
FACILITY NAME:MCBRAYER, MICHELLE FCCHFACILITY NUMBER:
173010786
ADMINISTRATOR:MICHELLE MCBRAYERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 350-5345
CITY:CLEARLAKESTATE: CAZIP CODE:
95422
CAPACITY:14CENSUS: 5DATE:
07/18/2025
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Michelle McBrayerTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff are not providing adequate supervision to children playing in unfenced area
INVESTIGATION FINDINGS:
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A complaint investigation visit was conducted today by Licensing Program Analyst (LPA), Sebastian Phouthavong to initiate the investigation and met with Licensee, Michelle McBrayer (LS) to discuss the allegation. It is Staff are not providing adequate supervision to children playing in unfenced area.

During the course of the investigation on 07/18/2025, LPA conducted an interview with the Licensee (LS), one staff (S1) and three daycare children (C2-C4). LS and S1 admitted that there was an incident when a daycare child eloped from the facility due to inefficient supervison. LS and S1 further stated, even though the daycare children were not playing in the front yard, the child was able to leave through the front door and past the unfenced area, leaving the premise and was missing for rouchly 10 minutes. LS and S1 also stated S1 found the child a few houses over and was with a neighborhood resident.

Additinally, from LS, S1 and children interviews (C2 &C3), confirmed daycare children are allowed to play past the unfanced yard,off the primse and on the street with oncoming cars driving by.
(Continued on LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025
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-20250717155029
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: 173010786
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/21/2025
Section Cited
HSC
1597.58(c)(2)
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HSC 1597.58(c)(2) Absence of supervision, including, but not limited to, a child left unattended, and a child left alone with a person under 18 years of age. This requirement is not met as evidenced by:
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Licensee create a plan of operation to provide adequate supervision at all times including when children are at the home’s outdoor areas. Also ensuring that the daycare children are not able to leave the premise. The facility’s plan will be completes/submitted on 07/21/2025
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Based on the Licensee and one staff interviews, one daycare child eloped from the facility and found with a neighborhood resident. This poses an immediate health and safety risk to children in care. A civil penalty of $500 is being issued for absence of supervision.
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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: 07/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 01-CC-20250717155029
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: 173010786
VISIT DATE: 07/18/2025
NARRATIVE
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(Continued from LIC9099)

Based on the information gathered during this investigation, the preponderance of the evidence standard has been met. Therefore, the allegation is determined to be substantiated. Health & Safety Code 1597.58(c)(2) is being cited on the attached LIC 9099-D resulting in an immediate civil penalty of $500 for absence of supervision. Appeal rights were provided.

Reports citing Type A violations are to be provided to parents/guardians of children currently enrolled by the next business day or the next day the children are in care, and to parents/guardians of children newly enrolled at the facility for the next 12 months from the date of this report. Parents/guardians must sign Form LIC 9224 to be kept in each child's file.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3