390300413-1-28-2022-53-CC-JSMH-CBVPRA-20220222103222

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 390300413
Report Date: 01/28/2022
Date Signed: 01/28/2022 12:27:46 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 Elvira Sierra

PUBLIC

COMPLAINT CONTROL NUMBER: 53-CC-20211108151136

FACILITY NAME:	LODI DAY NURSERY SCHOOL		FACILITY NUMBER:	390300413
ADMINISTRATOR:	RACHAEL KULLING		FACILITY TYPE:	850
ADDRESS:	760 S HAM LANE		TELEPHONE:	(209) 334-6884
CITY:	LODI	STATE: CA	ZIP CODE:	95242
CAPACITY:	135	CENSUS: 53	DATE:	01/28/2022
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Rachael Kulling		TIME COMPLETED:	12:35 PM

ALLEGATION(S):

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Absence of Supervision-Daycare children left unattended for a period of time

INVESTIGATION FINDINGS:

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On Friday, January 28,20222, Licensing Program Analysts (LPA) Elvira Sierra met with Director, Rachael Kulling to deliver findings for the above allegation. Upon arrival present in the facility were 13 staff and 53 children.
The complainant alleged Daycare children were left unattended for a period of time. LPA observed the care and supervision of children, interviewed staff, children and parents regarding the allegation. Through interviews and documents received LPA learned that at least in one ocassion C1 was left unsupervised outside the classroom while children were napping.

Based upon interviews and record reviews, the preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED. Title 22 Regulation deficiency cited on attached LIC9099-D. This report must be posted for 30 days and must be provided to the parents of the children currently in care, as well as the parents of children enrolled over the next 12 months.
An Exit Interview was conducted in which the report was reviewed and discussed with Director. Appeal of Rights were provided.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2022

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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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: 01/28/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/31/2022 Section Cited CCR 1596.99(c)(3)	1 2 3 4 5 6 7	1596.99(c)(3) (c) The department shall assess an immediate civil penalty of five hundred dollars ($500) per violation and one hundred dollars ($100) for each day the violation continues ....:(3) Absence of supervision, including, but not limited to, a child left unattended, and supervision of a child by a person under 18 years of age.	1 2 3 4 5 6 7	Director stated she will make sure that someone from the office will assist as needed if a child is out of order during nap time. To prevent future occurrences,Director also stated that new staff was hired and the facility goal is to keep the children safe.The deficiency was cleared during todays inspection.
	8 9 10 11 12 13 14	This requirements was not met as evidence by; Interviews and records review revealed that at least in one occasion C1 was asked to sit in a bench outside the classroom during nap time with no direct supervision.	8 9 10 11 12 13 14	Facility's staff will complete a safety and supervision training on February 2, 2022 and will submit proof of training to LPA Sierra by email. The deficiency was cleared during todays inspection.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2022

LIC9099 (FAS) - (06/04)

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