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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 233008242
Report Date: 08/10/2023
Date Signed: 08/14/2023 02:43:43 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
08/04/2023 and conducted by Evaluator Robert Maciel
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20230804153658

FACILITY NAME:STULTZ FAMILY CHILD CARE HOMEFACILITY NUMBER:
233008242
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
08/10/2023
UNANNOUNCEDTIME BEGAN:
03:31 PM
MET WITH:Tonya StultzTIME COMPLETED:
04:50 PM
ALLEGATION(S):
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Provider's pet scratched daycare children.
INVESTIGATION FINDINGS:
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An unannounced complaint investigation visit was made to the facility by Licensing Program Analyst (LPA), Robert Maciel to investigate allegations filed against the facility. The LPA met Licensee, Tonya Stultz, today and spoke with her regarding the allegation. LPA toured the facility inside and out and requested facility documents. Today there were 5 children receiving care from 1 staff member.

During an interview with the Licensee, Tonya Stultz, she stated that her cat was able to enter rooms that children were playing in, that her cat has scratched children before, and that "pets will do that" in the context of scratching children. LPA observed a cat in the playroom while children were playing inside. Continued on LIC9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 01-CC-20230804153658
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: STULTZ FAMILY CHILD CARE HOME
FACILITY NUMBER: 233008242
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/24/2023
Section Cited
CCR
102423(a)(2)
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To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.

This requirement was not met as evidenced by:
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Licensee stated she will place the cat in her sons room during day care hours.
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During an interview with licensee, she stated she was aware of the cat having scratched children previously but that it is to be expected at a family child care home with pets. LPA observed a cat in the playroom with the children.
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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: 08/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 01-CC-20230804153658
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: STULTZ FAMILY CHILD CARE HOME
FACILITY NUMBER: 233008242
VISIT DATE: 08/10/2023
NARRATIVE
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Based on the evidence obtained, the preponderance of evidence standard has been met; therefore, the above allegation is 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 Licensee Tonya Stultz. 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.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4