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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 233006150
Report Date: 04/19/2024
Date Signed: 04/19/2024 10:58:26 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
03/19/2024 and conducted by Evaluator Robert Maciel
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20240319145024
FACILITY NAME:TALMAGE STATE PRESCHOOLFACILITY NUMBER:
233006150
ADMINISTRATOR:CHIRIBOGA, PAMFACILITY TYPE:
850
ADDRESS:2240 OLD RIVER ROADTELEPHONE:
(707) 467-5091
CITY:UKIAHSTATE: CAZIP CODE:
95482
CAPACITY:27CENSUS: 13DATE:
04/19/2024
UNANNOUNCEDTIME BEGAN:
09:04 AM
MET WITH:Pam ChiribogaTIME COMPLETED:
10:01 AM
ALLEGATION(S):
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Staff are not providing adequate supervision to day care children.
INVESTIGATION FINDINGS:
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On 4/19/24, Licensing Program Analyst (LPA) Robert Maciel conducted an unannounced complaint visit, and met with Director Pam Chiriboga . It was alleged that staff are not providing adequete supervision to day care children, specifically that a child was outside in the playground alone. Staff and adults were interviewed on 3/22/24, 4/3/24, and 4/16/24, which corroborate the allegation. During today’s visit, the facility was toured and records were reviewed.

Based on the evidence obtained, the preponderance of evidence standard has been met; therefore, the above allegations are found to be substantiated. California Code of Regulations, (Title 22), is being cited on the attached LIC 9099D. Appeal rights were provided. Exit interview conducted, and report was reviewed with the Director Pam Chiriboga. 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.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2024
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-20240319145024
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: TALMAGE STATE PRESCHOOL
FACILITY NUMBER: 233006150
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/17/2024
Section Cited
CCR
101229(a)(1)
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No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
This requirement is not met as evidenced by:
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Director stated all staff would view the "Attendance Procedures" and "Maintaining Accountability" videos from https://www.virtuallabschool.org/preschool/safe-environments/lesson-4 and sign a written statement
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Based on interviews, child 1 - 3 (C1-C3) were left outside during transition from the playground to indoors and without adult supervision which poses a potential health & safety risk to children in care.
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attesting to having viewed and understood the videos. Director states the facility will develop a system to count the number of children during transition.
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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: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2