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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 570310219
Report Date: 05/31/2024
Date Signed: 05/31/2024 02:19:03 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/21/2024 and conducted by Evaluator Jennie Tedlos
COMPLAINT CONTROL NUMBER: 53-CC-20240521130901
FACILITY NAME:DAVIS PARENT NURSERY SCHOOL #2FACILITY NUMBER:
570310219
ADMINISTRATOR:BECKY MONTGOMERYFACILITY TYPE:
850
ADDRESS:426 WEST EIGHTH STREETTELEPHONE:
(530) 757-5377
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY:36CENSUS: 25DATE:
05/31/2024
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Becky MontgomeryTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff do not provide adequate supervision to day care children.
INVESTIGATION FINDINGS:
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On May 31, 2024, Licensing Program Analysts (LPA) Jennie Tedlos met with Director (D1), Becky Montgomery to deliver the findings of the complaint investigation regarding the above allegation. LPA observed 25 children supervised by 2 staff members and 5 parents.
LPA Tedlos conducted an investigation regarding the complaint allegation listed above. LPA toured the facility and conducted interviews with Staff Members.

It was alleged that staff did not provide adequate supervision to children in care when using the restroom. LPA learned through interviews with staff that an incident occured on 5/14/2024 regarding Child 1 and Child 2 using the bathroom unsupervised and engaging in inappropriate touching.

Based on interviews the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. A Type-A Deficiency is cited on a subsequent 9099-D page.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024
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-20240521130901
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: DAVIS PARENT NURSERY SCHOOL #2
FACILITY NUMBER: 570310219
VISIT DATE: 05/31/2024
NARRATIVE
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An exit interview was conducted, and the report was reviewed with the Director, Becky Montgomery. LPA provided the Director with Appeal Rights. A Notice of Site visit was posted by LPA and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 53-CC-20240521130901
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: DAVIS PARENT NURSERY SCHOOL #2
FACILITY NUMBER: 570310219
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/31/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/03/2024
Section Cited
CCR
101229(a)(1)
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101229 Responsibility for Providing Care and Supervision (a)...shall provide care and supervision as necessary to meet the children's needs.(1) No child(ren) shall be left without the supervision of a teacher at any time, ...Supervision shall include visual observation.
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Director will conduct a training on supervision to staff members and have all staff members sign a form stating that they understand the training. Director will send LPA signatures by due date.
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This regulation was not met as evidenced by:Based on interviews, LPA learned of an incident where Child 1 and Child 2 were left unsupervised in the bathroom which resulted in inappropriate touching which poses an immediate health, safety, or personal rights 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.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3