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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343624295
Report Date: 01/31/2023
Date Signed: 01/31/2023 03:51:20 PM

Substantiated


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
01/24/2023 and conducted by Evaluator Josiah Gathing
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20230124152741
FACILITY NAME:KIDS COMPANY PRESCHOOLFACILITY NUMBER:
343624295
ADMINISTRATOR:GORDON-JONES, SHAYNAFACILITY TYPE:
850
ADDRESS:3850 CALIFORNIA AVENUETELEPHONE:
(916) 607-2029
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:45CENSUS: 11DATE:
01/31/2023
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Shayna Gordon-JonesTIME COMPLETED:
04:10 PM
ALLEGATION(S):
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Facility's building poses a hazard to day care children's safety.
INVESTIGATION FINDINGS:
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On January 31, 2023, at approximately 1:20 PM. Licensing Program Analyst (LPA) Josiah Gathing met with Licensee Shayna Gordon-Jones for the purpose of opening and closing a complaint investigation. It was alleged that the facility's building poses a hazard to day care children's safety.
During today's investigation, LPA observed tools and construction materials near the outdoor play area. Facility representative stated that the children were fully supervised during outdoor play and that construction never takes place while children are outdoors. However, there was no fence or barrier to separate outdoor construction from the play area.
Therefore, based on observation, the preponderance of evidence standard has been met, and the allegation is substantiated.

CONT. ON LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023
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-20230124152741
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: KIDS COMPANY PRESCHOOL
FACILITY NUMBER: 343624295
VISIT DATE: 01/31/2023
NARRATIVE
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Title 22 deficiencies are cited on the subsequent pages of this report. Director acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 9099D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee. LIC 9224 and Appeal Rights were provided. Director's signature on this report acknowledges receipt of these rights. This report was reviewed with the Director. An exit interview was conducted. A Notice of Site Visit was provided and shall remain posted for a period of 30 days.
Upon receipt, facility representative shall post and provide copies of this licensing report to parents/ guardians of children who are currently enrolled as well as parents/ guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must acknowledge receipt of this report and citation by signing a LIC9224, “ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS”. A copy of this form should be placed in each child file upon receipt from parent.
LPA discussed this report with Licemsee and conducted an exit interview. LPA also provided appeal rights. Notice of site visit posted.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 03-CC-20230124152741
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: KIDS COMPANY PRESCHOOL
FACILITY NUMBER: 343624295
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/31/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/01/2023
Section Cited
CCR
101238.2(h)
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101238.2(h) Any construction or equipment that could pose a hazard in the outdoor activity area shall be made inaccessaible to children in care.
This requirement was not met as evidenced by:
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Licensee will have a barrier put in place to separate the construction equipment from the outdoor play area.
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Based on observation the facility did not comply with the above regulation as there was no barrier between the play area and construction equipment which poses 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: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3