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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 483009806
Report Date: 07/12/2024
Date Signed: 07/12/2024 02:29:53 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
07/10/2024 and conducted by Evaluator Elpidia Hernandez Torres
COMPLAINT CONTROL NUMBER: 01-CC-20240710090409
FACILITY NAME:FARFAN, EDITH FCCHFACILITY NUMBER:
483009806
ADMINISTRATOR:FARFAN, EDITHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 720-8550
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:14CENSUS: 34DATE:
07/12/2024
UNANNOUNCEDTIME BEGAN:
10:14 AM
MET WITH:Licensee Edith FarfanTIME COMPLETED:
02:35 PM
ALLEGATION(S):
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Licensee is operating over capacity
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Elpidia Hernandez Torres, conducted a complaint investigation inspection on 07/12/2024 at 10:14AM it is alleged the licensee is operating over capacity. LPA met with Licensee Edith Farfan to discuss the purpose of the visit and request children's roster LIC 9040. Upon LPAs arrival, LPA observed 34 children under direct supervision of licensee and licensee's assistant. The children were ranging between 12 months- 6 years old. While LPA was reviewing children's records guardians were arriving to pick up children. Licensee was granted a fire clearance for up to 14 children upon which license was based which limits the maximum capacity of 14 children when an assistant provider is present and based on the age of the 13th and 14th child Licensee acknowledged she was operating beyond the limitations of the license and fire clearance.

Continued on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024
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-20240710090409
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: FARFAN, EDITH FCCH
FACILITY NUMBER: 483009806
VISIT DATE: 07/12/2024
NARRATIVE
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Based on LPA's observations and interviews conducted the preponderance of evidence standard has been met and the above allegation is found to be substantiated. The California Code of Regulations, Title 22, Division 12 & Chapter 1, section 102416.5 (f) is being cited on attached LIC 9099D. This report was reviewed with the Licensee and an exit interview was conducted. Licensee’s signature was recorded on this Complaint Investigation Report (CIR), a copy and appeal rights were provided.

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. Exit interview conducted and report was reviewed with Licensee. LPA Hernandez Torres informed licensee that this report dated 07/12/2024 document(s) one Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Hernandez Torres informed licensee to provide a copy of this licensing report dated 07/12/2024 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: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 01-CC-20240710090409
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: FARFAN, EDITH FCCH
FACILITY NUMBER: 483009806
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/13/2024
Section Cited
CCR
102416.5(f)
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102416.5 Staffing Ratio and Capacity (f) The total licensed capacity for a Large Family Child Care Home shall not exceed fourteen children. . . This was not met as evidence by. . .
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Licensee reported the family child care home has two schedules set to ensure they stay within ratio. First schedule is from 5:00AM- 02:00PM, then 02:00PM-11:00PM. We will pick the 14 children to keep enrolled
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based on LPA's observation and interview conducted, Licensee was providing care and supervision for 34 children at one time. This is an immediate health and safety risk to children in care.
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based off of their schedule to ensure there is no overlap of children at the 2pm time. Licensee agreed to email, mail or fax the set schedule to LPA on or before 07/15/2024.
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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: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024
LIC9099 (FAS) - (06/04)
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