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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 393622079
Report Date: 02/21/2020
Date Signed: 02/27/2020 02:46:17 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
02/14/2020 and conducted by Evaluator Stacey Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20200214115631
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 Perdue TIME COMPLETED:
03:55 PM
ALLEGATION(S):
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Facility is over capacity
INVESTIGATION FINDINGS:
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** This is an amended report**
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 interviewed the complainant prior to today’s inspection. LPA discussed the complaint allegation with Licensee during today’s inspection. Licensee acknowledged being over capacity on February 11, 2020. Licensee stated she had an influx of drop in children on February 11, 2020 which caused her to miscount the number of children in care. Licensee stated this was an accident that has not occurred before.

Observations noted on February 11, 2020 from the complainant, pertinent information received during the investigation and Licensee’s acknowledgement of being over capacity reflect there was an immediate risk to the health and safety of children in care. A deficiency is cited based on the evidence received and the allegation is substantiated.

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 3
Control Number 53-CC-20200214115631
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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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 3
Control Number 53-CC-20200214115631
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
02/24/2020
Section Cited
CCR
102416.5(d)(2)
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(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either:
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**This is an amended report to reflect correct POC dates. **
Licensee will retake Family Childcare orientation by Plan of Correction (POC) date of 3/20/2020. Licensee will revise her current tracking tool to ensure an accurate daily count of children and ratio compliance is met by POC date of 2/24/2020.
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(2) More than twelve and up to fourteen children only if the criteria in Section 1597.465 of the Health and Safety Code are met.
This requirement was not met as evidenced by:
Licensee’s home was inspected on 2/11/2020 by an agency. During the time of the inspection, Licensee had 15 children present.This poses an immediate risk to the health and safety of children in care.
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Licensee will submit to Community Care Licensing a copy of the orientation certificate and a statement of review of the family childcare orientation as well as a copy of the revised child daily headcount tool used to monitor children in care. POC date for headcount tool is 2/24/2020. Submission of orientation certificate is 3/20/2020.
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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: 3 of 3