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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 493010057
Report Date: 12/20/2023
Date Signed: 12/20/2023 06:00:14 PM

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
10/16/2023 and conducted by Evaluator Robert Maciel
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20231016141452

FACILITY NAME:KCE CHAMPIONS LLC @ VALLEY VISTAFACILITY NUMBER:
493010057
ADMINISTRATOR:JUNIOR, TIFFANYFACILITY TYPE:
840
ADDRESS:730 N. WEBSTER STREETTELEPHONE:
(925) 457-7138
CITY:PETALUMASTATE: CAZIP CODE:
94952
CAPACITY:60CENSUS: DATE:
12/20/2023
UNANNOUNCEDTIME BEGAN:
05:39 PM
MET WITH:Jessica JoergerTIME COMPLETED:
06:10 PM
ALLEGATION(S):
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Facility staff handled child in a rough manner.
Staff do not ensure children are spoken to in an appropriate manner while in care.
Facility operating out of ratio.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Robert Maciel met with Director, Jessica Joerger for the purpose of delivering complaint investigation findings. It was alleged that the facility staff handled child in a rough manner, specifically dragged a child by her arms, that staff do not ensure children are spoken to in an appropriate manner while in care, and that the facility was operating out of ratio.

During today's visit, the facility was toured and records were reviewed. On 10/18/23, 12/07/23, and 12/20/23, LPA observed the facility operating in ratio. Interviews on 10/18/23, 11/14/23, and 12/07/23 with children and adults do not corroborate the allegation.

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.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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