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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 393622079
Report Date: 02/21/2020
Date Signed: 02/21/2020 04:08:41 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
01/06/2020 and conducted by Evaluator Stacey Williams
COMPLAINT CONTROL NUMBER: 53-CC-20200106115148
FACILITY NAME:PERDUE, KRISTIFACILITY NUMBER:
393622079
ADMINISTRATOR:PERDUE, KRISTIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 740-0165
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY:14CENSUS: 12DATE:
02/21/2020
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Kristi PerdueTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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9
Uncleared adult providing care and supervision to the children in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Stacey Williams arrived at the home of Licensee, Kristi Perdue at 1:20 PM. LPA met with Licensee, Kristi Perdue and toured the inside of the home. LPA observed twelve children supervised by Licensee and her Assistant. Eleven children were preschool aged, and one child was an infant. Children were transitioning from awakening from nap during the walk through of the home. Both Licensee and her Assistant have criminal record clearances on file.

LPA conducted an investigation regarding the allegation listed above.The facilty home was toured, records were reviewed and interviews were conducted with the complainant, Licensee, Licensee's Assistant, and parents of childcare children supervised by the Licensee. It was alleged that childcare children were left with a relative of the Licensee who did not have a criminal record clearance. Pertinent documentation was received throughout the investigation. Licensee acknowledged three occurrences where her relative helped supervise children with her Assistant who has criminal record clearances. Licensee reported that parents were notified of the potential change in staffing due to her daughter's health condition at the time. A review of criminal record clearances for individuals associated to the Licensee's facility license did not indicate criminal record clearance for her relative prior to January 14, 2020.
-Report continues on LIC9099C-
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020
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 5
Control Number 53-CC-20200106115148
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: PERDUE, KRISTI
FACILITY NUMBER: 393622079
VISIT DATE: 02/21/2020
NARRATIVE
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A deficiency is being cited based on the evidence received and the allegation is substantiated. Civil penalties for repeat violation is also being assessed during today's inspection.

Title 22 Deficiency has been cited on the attached LIC 9099D. Upon receipt of Type A citations, facility shall post and provide copies of the LIC 9099D for parents/guardians of children currently in care and for parents/guardians of newly enrolled children for the next 12 months. Facility must also keep the signed LIC 9224, acknowledging receipt of Licensing Reports LIC 9099D in each child's files.

An exit interview was conducted, and a Plan of Correction was reviewed and developed with the Licensee. A copy of this report and appeal rights were discussed and left the Licensee, Kristi Perdue whose signature on this form confirm receipt of these documents. Notice of Site Visit was provided to Licensee to post during today’s inspection.

SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
01/06/2020 and conducted by Evaluator Stacey Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20200106115148

FACILITY NAME:PERDUE, KRISTIFACILITY NUMBER:
393622079
ADMINISTRATOR:PERDUE, KRISTIFACILITY TYPE:
810
ADDRESS:2730 PONTE MIRA WAYTELEPHONE:
(209) 740-0165
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY:14CENSUS: 12DATE:
02/21/2020
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Kristi PerdueTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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9
Facility operating out of ratio.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Stacey Williams arrived at the home of Licensee, Kristi Perdue at 1:20 PM. LPA met with Licensee, Kristi Perdue and toured the inside of the home. LPA observed twelve children supervised by Licensee and her Assistant. Eleven children were preschool aged, and one child was an infant. Children were transitioning from awakening from nap during the walk through of the home. Both Licensee and her Assistant have criminal record clearances on file.

LPA conducted an investigation regarding the allegation listed above. The facility home was toured, records were reviewed and interviews were conducted with the complainant, Licensee, Licensee's Assistant, and parents of childcare children supervised by the Licensee. It was alleged that Licensee was out of ratio while absent from the home. Licensee denied the allegation and reported that she left the children with two of her assistants. Inconsistent statements were received regarding the number of children present in the home. Based on the information received the allegation is determined to be unsubstantiated. 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.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020
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 5
Control Number 53-CC-20200106115148
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: PERDUE, KRISTI
FACILITY NUMBER: 393622079
VISIT DATE: 02/21/2020
NARRATIVE
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An exit interview was conducted. A copy of this report and appeal rights were discussed and left the Licensee, Kristi Perdue whose signature on this form confirm receipt of these documents. Notice of Site Visit was provided to Licensee to post during today’s inspection.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 53-CC-20200106115148
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: PERDUE, KRISTI
FACILITY NUMBER: 393622079
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/21/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/21/2020
Section Cited
CCR
102370(d)(1)
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Criminal Record Clearance. All individuals subject to a criminal record review as specified in Section 1596.871 prior to working, residing or volunteering in a licensed home, shall obtain a California clearance
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Licensee obtained criminal record clearance for her relative . Licensee will take the family childcare orientation online to review licensure requirements. This plan of correction is cleared.
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 or a criminal record exemption as required by the Department. This requirement was not met as evidenced by: Licensee acknowledged her relative helped her Assistant supervise children in care for three occurrences prior to obtaining criminal record clearance. This is an immediate risk to the health and safety of children in care.
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Civil Penalty assessed due to a repeat violation.
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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: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020
LIC9099 (FAS) - (06/04)
Page: 5 of 5