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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 233008242
Report Date: 09/22/2023
Date Signed: 09/22/2023 11:42:14 AM

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
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: 2DATE:
09/22/2023
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:TIME COMPLETED:
11:55 PM
ALLEGATION(S):
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Daycare child sustained diaper rash while in care.

Provider left daycare child unsupervised resulting in daycare child to fall.

Facility smells of urine.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Robert Maciel met with Licensee, Tonya Stultz, for the purpose of delivering complaint investigation findings. It was alleged that the licensee did not secure a child in a highchair properly, A child fell out of a bench while the licensee was not supervising the child, a child sustained diaper rash while in care, and that the facility smelled of urine upon entry.

The licensee was interviewed on 8/10/23 at 1:50 PM and stated that a child was able to enter the bathroom unsupervised and play in a cat's litter box. 2 adults were interviewed on 8/14/23 and stated that there was no history of the licensee improperly cleaning children during diaper changes. Adult 5 (A5) was interviewed on 8/14/23 and stated that they smelled urine in the facility upon pickup and that the two children they picked up were unusually dirty and smelled of soiled cat litter. On 8/10/23, child 3 (C3) was interviewed.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023
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 5
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
COMPLAINT CONTROL NUMBER: 01-CC-20230804153658

FACILITY NAME:STULTZ FAMILY CHILD CARE HOMEFACILITY NUMBER:
233008242
ADMINISTRATOR:STULTZ, TONYAFACILITY TYPE:
810
ADDRESS:516 SOUTH SPRING STREETTELEPHONE:
(707) 463-2443
CITY:UKIAHSTATE: CAZIP CODE:
95482
CAPACITY:8CENSUS: 2DATE:
09/22/2023
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Tonya StultzTIME COMPLETED:
11:55 PM
ALLEGATION(S):
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Provider did not secure daycare child in a highchair.
INVESTIGATION FINDINGS:
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Upon further review, a subsequent unannounced complaint investigation visit was made to the facility by Licensing Program Analyst (LPA), Robert Maciel to further investigate an allegation filed against the facility. The LPA met Licensee, Tonya Stultz, today and spoke with her regarding the allegation that she did not secure daycare child in a highchair. Specifically that she placed 10 month old Child 1 (C1) on a picnic table bench for mealtime, instead of securing C1 in a highchair. LPA toured the facility inside and out and requested facility documents. Today there were 2 children receiving care from 1 staff member. On 8/10/23, during an interview with the Licensee, Tonya Stultz, she stated that any child she feels is able to sit up in a regular chair does not require a highchair. On 8/10/23 LPA observed a highchair without any straps to secure a child. Licensee stated that the straps were dirty and being washed, after which they would be replaced. On 8/10/23 LPA advised Licensee that all equipment must be used for its intended purpose, according to manufacturing guidelines, age limitations, and including but not limited to, securing a child in a highchair with the appropriate safety straps while in use. Continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023
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 5
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: 09/22/2023
NARRATIVE
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On 8/29/23 LPA observed that the picnic table in the front patio has no information written on it that indicates the appropriate age of use. On 9/22/23 LPA asked Licensee if she had the manual for the picnic table that states the appropriate age of use, Licensee stated that she did not but showed the LPA a record of purchase of the picnic table. A search of the picnic table on the manufacture's website indicates a recommended age limit of 3-8 years old. LPA observed a photograph posted to Facebook on 4/19/23 of C1 and Child 2 (C2) sitting at the front patio picnic table. C1 and C2 are sitting next to each other eating. C1 is shown unsecured on the bench with his back to the patio fence and was 10 months old at the time of the photograph.

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: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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: 09/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/13/2023
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 states that she will henceforth place all children under 3 years old, on a mat to eat.
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Based on interview, Licensee stated she seated a child on a table who was outside of the listed age of use for the table which poses a potential health, safety or personal rights risk to persons in care.
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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: 09/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
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: 09/22/2023
NARRATIVE
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During today’s visit, the facility was toured and records were reviewed. On 8/10/23, LPA smelled no urine in the facility.

Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred, and the findings are unsubstantiated. An exit interview was conducted. The Notice of Site Visit must be posted for 30 days.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5