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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 390300413
Report Date: 01/19/2023
Date Signed: 01/19/2023 11:13:05 AM

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
12/12/2022 and conducted by Evaluator Nola Maestas
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20221212135504
FACILITY NAME:LODI DAY NURSERY SCHOOLFACILITY NUMBER:
390300413
ADMINISTRATOR:RACHAEL KULLINGFACILITY TYPE:
850
ADDRESS:760 SOUTH HAM LANETELEPHONE:
(209) 334-6884
CITY:LODISTATE: CAZIP CODE:
95242
CAPACITY:135CENSUS: 58DATE:
01/19/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Rachael KullingTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff did not provide child's authorized representative access to information regarding the child's care.
Staff did not report suspected child abuse as required.
INVESTIGATION FINDINGS:
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On 01/19/2022, Licensing Program Analyst Katy Maestas (LPA1) and Licensing Program Analyst Carla Polanco (LPA2) conducted an unannounced field visit to deliver the findings for the above allegations. LPAs met with Director Racheal Kulling (D1). Throughout the course of the investigation, LPAs conducted observations, interviews, reviewed and collected documents.
It was alleged that staff did not provide a child’s authorized representative access to information regarding the child’s care. Interviews revealed that the child’s mother had requested a handbook and one was not provided until after Licensing was informed. Documentation supports statements made in interviews. Based on interviews, file reviews, and observations conducted the preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED.
It was alleged that staff did not report suspected abuse as required by Mandated Reporter duties. Interviews revealed that a staff member was told of an incident of possible abuse involving an enrolled child. Staff did not report the suspected abuse within 24 hours as required by regulation. Based on interviews, file reviews, and observations conducted the preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED.
An exit interview was conducted with D1and Appeal Rights were provided. A Notice of Site Visit was posted by LPA and this shall be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Nola MaestasTELEPHONE: 916-926-9100
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023
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 53-CC-20221212135504
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: 01/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/26/2023
Section Cited
CCR
101218.1(b)
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Admission Procedures and Parental and Authorized Representative's Rights...(b) Provides the child's parent or authorized representative with information about the child care center that shall at least include the child care center's admission policies and procedures, activities, services,
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D1 stated that enrollment process will include two packets with handbooks for two sets of parents.
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regulations, hours and days of operation, fees, procedures to be followed should the child become ill or injured while at the child care center, and procedures for conducting inspections for illness. This requirement was not met as evidenced by a mother not receiving a requested handbook.


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Type B
01/26/2023
Section Cited
CCR
101212
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(d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information
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D1 will email LPA Maestas a signed statement confimring her understanding of Mandated Reporter Duties by 01/26/2023.
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specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. (1)(D) Any suspected physical or psychological abuse of any child. This requirement was not met as evidenced by suspected abuse not being reported within 24 hours.
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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: Nola MaestasTELEPHONE: 916-926-9100
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2