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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 390300413
Report Date: 01/13/2022
Date Signed: 01/13/2022 05:16:21 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/08/2021 and conducted by Evaluator Jeevun Birk
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20211108151136
FACILITY NAME:LODI DAY NURSERY SCHOOLFACILITY NUMBER:
390300413
ADMINISTRATOR:RACHAEL KULLINGFACILITY TYPE:
850
ADDRESS:760 S HAM LANETELEPHONE:
(209) 334-6884
CITY:LODISTATE: CAZIP CODE:
95242
CAPACITY:135CENSUS: 44DATE:
01/13/2022
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Rachel KullingTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility staff are not wearing face mask
INVESTIGATION FINDINGS:
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On Thursday January 13, 2022 at 4:00 PM Licensing Program Analysts (LPA) Jeevun Birk-Miller and Katy Maestas conducted an unannounced complaint investigation inspection and met with Director, Rachel Kulling to deliver findings for the above allegation. It was alleged that staff in the facility are not wearing masks. During the course of the investigation, LPA Elvira Sierra conducted interviews and obtained information pertaining to the allegation. Interviews revealed that staff are not always wearing a mask while indoors. LPA learned during interviews that some of the staff are not wearing mask indoors because it impedes the children's ability to receive and interpret information since children are not able to see the teachers’ mouth move. It was also stated that a medical issue makes it hard to wear a mask as well. Parents that were interviewed corroborate the allegation and observed some of the staff not wearing mask in several occasions. During today's inspection LPAs Birk-Miller and Maestas observed a majority of the staff were not wearing or properly wearing masks indoor. It was also observed that children were also not wearing masks. Based on the interviews and observation conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.
Substantiated
Estimated Days of Completion: 90
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Jeevun BirkTELEPHONE: (916) 917-6078
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2022
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 53-CC-20211108151136
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: LODI DAY NURSERY SCHOOL
FACILITY NUMBER: 390300413
VISIT DATE: 01/13/2022
NARRATIVE
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The following Type A deficiency was cited on the 809-D page of this report. Upon receipt, Facility shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. The LIC 9224 must be signed by parents/guardians and kept as a receipt whenever any Type A documents are provided by the facility. LIC 9224 is available on the website. If the LIC 9224 is not used, the licensee shall prepare a statement indicating the documents have been provided. Licensee shall require the parent/guardian to sign and date the statement and shall keep the signed statement as receipt. Verification of receipt shall be kept in each child's file at the facility. Appeal Rights were provided. An exit interview was conducted. A Notice of Site Visit was given and posted by LPA Birk-Miller. This is to remain posted for 30 days.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Jeevun BirkTELEPHONE: (916) 917-6078
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 53-CC-20211108151136
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: LODI DAY NURSERY SCHOOL
FACILITY NUMBER: 390300413
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/14/2022
Section Cited
CCR
101223(a)(2)
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To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.



This requirement was not met as evidenced by:
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Director agrees to submit a plan of action which includes how she will ensure masks are being properly worn, staff training, posting requirements, and updating the facility's policies on masks by 1/14/2021.
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Based on interviews and observation the facility did not ensure masks were worn by all staff and children in care. This poses an immediate health and safety 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.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Jeevun BirkTELEPHONE: (916) 917-6078
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3