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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 493008053
Report Date: 07/16/2021
Date Signed: 07/19/2021 12:07:08 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/25/2021 and conducted by Evaluator Mary Trinh
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20210625151504
FACILITY NAME:TINY TREASURES PRESCHOOLFACILITY NUMBER:
493008053
ADMINISTRATOR:FLEMING, CLAIREFACILITY TYPE:
850
ADDRESS:6170 MONTECITO BLVD.TELEPHONE:
(707) 539-8469
CITY:SANTA ROSASTATE: CAZIP CODE:
95409
CAPACITY:64CENSUS: 17DATE:
07/16/2021
ANNOUNCEDTIME BEGAN:
03:55 PM
MET WITH:Beth FioriTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Day care child sustained injuries while in care.
INVESTIGATION FINDINGS:
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Licensing Program (LPA) Mary Trinh met with Beth Fiori, Director (D1) to deliver complaint findings. It was alleged that Day care child sustained injuries while in care. On 06/28/2021 LPA Trinh interviewed D1(at 3:30 pm), Staff 1 (at 3:35 pm) and Staff 2 (at 3:40 pm). D1, Staff 1 and Staff 2 confirm that Child 1 (C1) has self injurious behaviors such as running into walls or doors. D1 and Staff confirm if C1 did sustain injuries it was either done to himself and not while in facility care.
On 06/28/2021 at 12:25 pm LPA Trinh interviewed Adult 1 (A1). On 07/06/2021 at 4:05 pm, LPA Trinh interviewed Adult 2 (A2). A1 and A2 confirms that C1 does not have self injurious behaviors such as running into wall or door.
Continued...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Mary Trinh
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021
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 2
Control Number 01-CC-20210625151504
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: TINY TREASURES PRESCHOOL
FACILITY NUMBER: 493008053
VISIT DATE: 07/16/2021
NARRATIVE
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This agency has investigated the complaint alleging that Day care child sustained injuries while in care. We have found that the complaint is Unsubstantiated.
Based on the information gathered during this investigation, there is insufficient information to prove or disprove the allegations as reported. There is not a preponderance of the evidence to prove the allegations, therefore the findings are determined to be Unsubstantiated.
Advisory on Reporting Requirements 101212(1)(C) was explained to D1. Although children might not be injured at the facility, Unusual Incident Reports (UIR) should be completed if Staff observes any unusual behaviors that are self injurious such as running into wall or door.
Appeal rights printed and given to Licensee.
Notice of site visit printed and given to Licensee to post where parents can see.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Mary Trinh
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2