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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 173010434
Report Date: 05/22/2025
Date Signed: 05/22/2025 09:48:34 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/26/2025 and conducted by Evaluator Sebastian Phouthavong
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20250226092906
FACILITY NAME:STULTZ RACHAEL FCCHFACILITY NUMBER:
173010434
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
05/22/2025
UNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Rachael StultzTIME COMPLETED:
10:10 AM
ALLEGATION(S):
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Licensee is not present at facility the required amount of time
INVESTIGATION FINDINGS:
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A subsequent complaint investigation visit was conducted today by Licensing Program Analyst (LPA), Sebastian Phouthavong who met with Licensee, Rachael Stultz (LS) for the purpose of delivering complaint investigation finding for the above allegation. LPA, previously conducted an inspection on 02/28/2025 to initiate the investigation and met with Licensee to discuss the allegations, conduct interview(s), make observations, and request documents. LPA also conducted an inspections on 03/12/2025, 04/09/2025 & 05/06/2025. It is alleged Licensee is not present at facility the required amount of time.

During the course of the investigation, LPA conducted interviews with Licensee (LS), two children (C1 & C2), 2 Adults (A1, A3 & A4) and attempted one Adult (A2) interview from 02/28/2025 to 05/22/2025. LS stated to be the only childcare provider and would stay at the facility during the hours of operation/and or when daycare children are present. LS also stated that the facility would close if needed time off and/or an emergency occurred.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025
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 01-CC-20250226092906
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: STULTZ RACHAEL FCCH
FACILITY NUMBER: 173010434
VISIT DATE: 05/22/2025
NARRATIVE
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Interviews conducted by Adults (A3 & A4) stated to have no current concerns with the allegation filed against the facility. However, from one adult interview (A1) indicated there was a personal reason that may have kept LS from being present and providing care at the facility, however no corroborating evidence was revealed.

In addition, upon LPA’s inspections on 03/12/2025, 04/09/2025 & 05/06/2025, LS was observed at the facility and proving care to daycare children. It was also indicated by individuals residing at the home that they would often assist at the facility with LS being present.

Based on the information gathered during this investigation, although the allegations may have happened or is valid, there is not a preponderance of evidence to prove that the allegations occurred and therefore are determined to be unsubstantiated. There were no Title 22 deficiencies cited. This report was reviewed and discussed with Licensee, Rachael Stultz (LS). Appeal rights were provided. Notice of Site Visit shall be posted for 30 days from today's visit.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2