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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343622148
Report Date: 02/20/2025
Date Signed: 05/14/2025 02:35:21 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO 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
02/18/2025 and conducted by Evaluator Julia Maryanova
COMPLAINT CONTROL NUMBER: 03-CC-20250218122821
FACILITY NAME:DAVIS, KATIEFACILITY NUMBER:
343622148
ADMINISTRATOR:DAVIS, KATIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 425-5118
CITY:SACRAMENTOSTATE: CAZIP CODE:
95820
CAPACITY:14CENSUS: 2DATE:
02/20/2025
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Katie DavisTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Licensee not maintaining the facility clean
Licensee not maintaining the facility yard free of debris
INVESTIGATION FINDINGS:
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This is an amended report due to incorrect date on the original report.

On Thursday, February 20, 2025, at approximately 1:30PM Licensing Program Analysts (LPA) Julia Maryanova and Licensing Program Manager (LMP) Amanda Blessi met with Licensee, Katie Davis, for the purpose of a complaint investigation and to deliver findings. Also present was Assistant Robin, Licensee's two minor children and no daycare children were present at the time of the inspection. It was alleged that 1) Licensee not maintaining the facility clean 2) Licensee not maintaining the facility yard free of debris. Throughout the course of the investigation, LPA conducted interview and made observations. During the investigation, LPA observed that the yard is not free of debris and the facility is not maintained clean. Based on observation the preponderance of evidence standard has been met and above allegations are substantiated.

Deficiencies are noted on subsequent page of this report LIC9099-D. An exit interview was conducted and a notice of site visit provided. Notice of site visit shall remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Julia Maryanova
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
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 3
Control Number 03-CC-20250218122821
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: DAVIS, KATIE
FACILITY NUMBER: 343622148
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/17/2025
Section Cited
CCR
102417(b)
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102417 Operation of a Family Child Care Home (b) The home shall be kept clean and orderly...
This requirement was not met as evidenced by:
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Licensee agrees to clean and sanitize the facility by the Plan of Correction date. LPA will make a return visit to verify corrections.
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Based on observation the facility did not comply with the above regulation as the floors need to be cleaned and sanitized, the kitchen needs to be cleaned, bathroom and rooms need to be free of clutter and tidied up, which poses a potential Health, Safety, or Personal Rights risk to persons in care.
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Type B
03/17/2025
Section Cited
CCR
102417(g)
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102417 Operation of a Family Child Care Home (g) The home shall be free from defects or conditions which might endanger a child...
This requirement was not met as evidenced by:
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Licensee will have a junk removal company on March 12th and 14th to remove old furnature, debris, broken itmes from the front and back yard. LPA will make a return visit to verify corrections.
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Based on observation the facility did not comply with the above regulations as the backyard was not free of debris which poses a potential Health, Safety, or Personal Rights risk to persons 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: Amanda Blesi
LICENSING EVALUATOR NAME: Julia Maryanova
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3