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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 390300413
Report Date: 06/16/2022
Date Signed: 06/16/2022 05:24:28 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, 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
06/06/2022 and conducted by Evaluator Chayntel Hunter
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20220606102610
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: 27DATE:
06/16/2022
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Director, Rachael KullingTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Facility did not notify parent(s) of COVID-19 exposure.
Facility did not notify parent(s) of updates regarding their child and the program.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Chayntel Hunter and Christopher Jackson met with Director, Rachael Kulling to open and close the complaint investigation regarding the above allegations. During the course of the investigation, LPA Hunter conducted interviews, and obtained information pertaining to allegations. It was alleged that the facility did not notify parents of a COVID19 exposure, or about updates regarding a child in their program. Interviews conducted revealed that the facility sent out a blanket email to parents regarding an exposure, and overlooked a couple parents emails. Although the entire facility wasn't exposed, due to the program combining children the email was sent to all parents. It was also determined that the facility overlooked inputting parents' emails and therefore parents were not notified of schedule changes and updates to their child. A review of records also determined that a change was made to a child's schedule without consent from one of the authorized representatives. The facility has since ensured that all files are up to date and that they will reach out to parents if information is incomplete or missing.

Report continues 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Justin L DentonTELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
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 4
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
06/06/2022 and conducted by Evaluator Chayntel Hunter
COMPLAINT CONTROL NUMBER: 53-CC-20220606102610

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: 27DATE:
06/16/2022
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Director, Rachael KullingTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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9
Staff did not verify identification of authorized adult who picked up child from care.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Chayntel Hunter and Christopher Jackson met with Director, Rachael Kulling to open and close the complaint investigation regarding the above allegation.

During the course of the investigation, LPAs Hunter and Jackson conducted interviews, and obtained information pertaining to the above allegation. It was alleged that an authorized adult was allowed to pick up a child from care without their identification being checked. Interviews conducted revealed inconsistent information as to whether staff knew the authorized adult, and identification had already been checked prior to the pick up. Based on the information obtained throughout the course of this investigation the above allegation could not be substantiated or dismissed. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the finding is UNSUBSTANTIATED. Exit interview was conducted. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Justin L DentonTELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 53-CC-20220606102610
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: 06/16/2022
NARRATIVE
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Based on the interviews and review of records the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Title 22 regulations are being cited on the attached 9099-D page.

An exit interview was conducted with the Director. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Justin L DentonTELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 53-CC-20220606102610
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: 06/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/18/2022
Section Cited
CCR
101219(d)
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Admission Agreements 101219 (d) Modifications to the original admission agreement shall be made ... and shall be dated and signed by... (c)... the child's authorized representative. This requirement was not met as evidenced by:
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Director stated that anytime a change is made to the child's schedule, the facility will obtain written notification from parents. The facility will also obtain written notification if a parent/guardian wishes to designate another party as an authorized representative.
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Based on interviews conducted and a review of records, it was determined that a change was made to a child's schedule without consent from one of the authorized representatives. This is a potential 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: Justin L DentonTELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4