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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 233008242
Report Date: 05/15/2024
Date Signed: 05/15/2024 11:32:25 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
05/07/2024 and conducted by Evaluator Robert Maciel
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20240507081143
FACILITY NAME:STULTZ FAMILY CHILD CARE HOMEFACILITY NUMBER:
233008242
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
05/15/2024
UNANNOUNCEDTIME BEGAN:
09:37 AM
MET WITH:Tonya StultzTIME COMPLETED:
11:46 AM
ALLEGATION(S):
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Uncleared adult has access to day care children in care.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Robert Maciel and Sebastian Phouthavong conducted an unannounced complaint visit, and met with the licensee, Tonya Stultz. It was alleged that and uncleared adult has access to day care children in care. During today’s visit, the facility was toured and records were reviewed.

On 5/15/24, the licensee was interviewed and confirmed that there was an uncleared adult, A1, who resided in the home from 3/28/24 - 4/9/24 and from 4/26/24 - 5/4/24. Furthermore, a report from local law enforcement and an interview with C1 corroborate the allegation. The facility is in violation of criminal record clearance requirements due to an uncleared adult residing in the facility and/or being in the presence of children in care and thus, an immediate Civil Penalty is being assessed.
(Continues on LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024
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 3
Control Number 01-CC-20240507081143
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: 05/15/2024
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. Because this is a subsequent violation within a 12-month period, the civil penalty shall be assessed for 22 days. Appeal rights were provided and exit interview conducted. The Notice of Site Visit must be posted for 30 days.

Type A citation shall be posted for 30 consecutive days as there is immediate risk(s) to the health, safety, or personal rights of children in care. LPAs informed the licensee to provide a copy of this licensing report dated 5/15/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 01-CC-20240507081143
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: 05/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/16/2024
Section Cited
CCR
102370(d)
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All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility. . .this requirement was not met as evidenced by
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LPA provided the Licensee the criminal record clearance requirements to the Licensee who will review them and submit a statement of her understanding of the requirements.
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based on interviews conducted with LS and C1, an uncleared adult was residing in the home from 3/28/24-4/9/24 and from 4/26/24 to 5/4/24 which poses an immediate health, saftey and/or personal rights risk to children 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: 05/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3