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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 483010481
Report Date: 08/28/2024
Date Signed: 08/28/2024 03:49:11 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
08/22/2024 and conducted by Evaluator Elpidia Hernandez Torres
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20240822162525
FACILITY NAME:BAYNORTH LEARNING CENTER - PRESCHOOLFACILITY NUMBER:
483010481
ADMINISTRATOR:JACKSON, JACQUELINEFACILITY TYPE:
850
ADDRESS:2100 PENNSYLVANIA AVENUETELEPHONE:
(707) 720-5278
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:53CENSUS: 9DATE:
08/28/2024
UNANNOUNCEDTIME BEGAN:
07:55 AM
MET WITH:Facility Representative TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff did not follow reporting requirements
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs), Elpidia Hernandez Torres and Melinda Mohr, conducted a complaint investigation. It is alleged, staff did not follow reporting requirements. On 08/22/2024 LPA Hernandez Torres received evidence of an injury requireing medical treatment that occurred on 08/19/2024. LPA was previously at the facility on 08/20/2024, and interviewed a facility representative and five staff, none of the people interviewed reported the injury from 08/19/2024. The regional office and officer of the day did not receive a call reporting the incident. The regional office did not receive a written report within seven days of the incident.

Based on interviews conducted and evidence received 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 101212(d) is being cited on attached LIC 9099D . This report was reviewed with the facility representative and an exit interview was conducted. Signature was recorded a copy was provided. Notice of Site Visit shall be posted for 30 days. Appeal Rights were provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
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-20240822162525
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: BAYNORTH LEARNING CENTER - PRESCHOOL
FACILITY NUMBER: 483010481
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/20/2024
Section Cited
CCR
101212(d)
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101212 Reporting Requirements. Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days . . . Thi was not met as evidence by. . .
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LPAs reviewed in-depth the appropriate procedure for UIRs. Facility representative reported moving forward the center will follow the appropriate procedure for UIRs and will submit a form to demonstrate all staff have been trained in the procedure.
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Based on evidence received and interviews conducted staff did not report an incident resulting in an injury requiring medical treatment. This poses a potential health and safety risk to children in care.
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Via email, mail or Fax to LPA Hernandez Torres on or before 09/20/2024.
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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: 08/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3