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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376618348
Report Date: 07/25/2023
Date Signed: 07/25/2023 04:56:01 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/09/2023 and conducted by Evaluator Michelle Hood
PUBLIC
COMPLAINT CONTROL NUMBER: 20-CC-20230509143322
FACILITY NAME:WILLIAMS, LACY FAMILY CHILD CAREFACILITY NUMBER:
376618348
ADMINISTRATOR:LACY WILLIAMSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 269-8331
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY:14CENSUS: 4DATE:
07/25/2023
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Lacy Williams, LicenseeTIME COMPLETED:
04:05 PM
ALLEGATION(S):
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Licensee did not ensure infant’s sleeping area is free from loose articles and object.
INVESTIGATION FINDINGS:
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On 07/25/2023 at 3:15 PM, Licensing Program Analyst (LPA) Michelle Hood conducted an unannounced complaint inspection for the purpose of delivering the findings regarding the above allegation. During today's inspection, the LPA did not interview daycare children due to three children were napping and one was non-verbal.

During the investigation, the LPA interviewed the licensee, reporting party, witnesses, and daycare parents. During the licensees interview, the licensee admitted placing an iPad and blanket in the pack-n-play to help calm the infant. The licensee stated she removed the blanket and iPAD after taking the picture of the infant asleep to the parent. One daycare parent stated they observed an infant napping with a blanket while at the facility. LPA reached out to four other daycare parents; however, there was no replies. During the review of the video and pictures provided by the licensee, LPA Hood and Dinh observed an infant asleep with a blue blanket and iPad in the pack-n-play.

The preponderance of evidence standard has been met; therefore, the allegation is found to be SUBSTANTIATED. One type A violation California Code of Regulations, (Title 22, Division 12 & Chapter 3), is being cited on the attached LIC 9099-D.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Michelle Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2023
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/09/2023 and conducted by Evaluator Michelle Hood
PUBLIC
COMPLAINT CONTROL NUMBER: 20-CC-20230509143322

FACILITY NAME:WILLIAMS, LACY FAMILY CHILD CAREFACILITY NUMBER:
376618348
ADMINISTRATOR:LACY WILLIAMSFACILITY TYPE:
810
ADDRESS:123 HENSON STREETTELEPHONE:
(619) 269-8331
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY:14CENSUS: 4DATE:
07/25/2023
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Lacy Williams, LicenseeTIME COMPLETED:
04:05 PM
ALLEGATION(S):
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Day care child sustained unexplained burns.
INVESTIGATION FINDINGS:
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On 07/25/2023 at 3:15 PM, Licensing Program Analyst (LPA) Michelle Hood conducted an unannounced complaint inspection for the purpose of delivering the findings regarding the above allegation. During today's inspection, the LPA did not interview daycare children due to three children were napping and one was non-verbal.

During the investigation, the LPA interviewed the licensee, reporting party, witnesses, and daycare parents. During the interview eith the licensee, the licensee stated she did not place any items in the pack-n-play that could burn the infant. The licensee stated she removed the iPad once she took a picture for the parent. One daycare parent stated they didn't recall observing an ipad charger in the pack-n-play where the infants nap. While reviewing the video and pictures, LPA Hood, and Dinh did not observe any marks on the infant to indicate the infant was burned while at the facility.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Michelle Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 20-CC-20230509143322
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: WILLIAMS, LACY FAMILY CHILD CARE
FACILITY NUMBER: 376618348
VISIT DATE: 07/25/2023
NARRATIVE
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Due to conflicting statements obtained during the investigation, the above allegation is found to be UNSUBSTANTIATED meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted, and the report was reviewed with the licensee Lacy Williams. The complaint report will be emailed to the licensee and the licensee was advised that acknowledgment of receipt are to be received within twenty-four hours. Licensee was provided appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. Notice of Site Visit (LIC 9213) was provided to be posted at the facility for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Michelle Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 20-CC-20230509143322
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: WILLIAMS, LACY FAMILY CHILD CARE
FACILITY NUMBER: 376618348
VISIT DATE: 07/25/2023
NARRATIVE
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An exit interview was conducted, and the report was reviewed with the licensee Lacy Williams. The complaint report will be emailed to the licensee and the licensee was advised that acknowledgment of receipt are to be received within twenty-four hours. Licensee was provided appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. Notice of Site Visit (LIC 9213) was provided to be posted at the facility for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. See the LIC 9099D page for the deficiency cited.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Michelle Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 20-CC-20230509143322
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: WILLIAMS, LACY FAMILY CHILD CARE
FACILITY NUMBER: 376618348
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/22/2023
Section Cited
CCR
102425(b)
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102425(b) INFANT SAFE SLEEP
Cribs or play yards shall be free from all loose articles and objects. This requirement was not met by:
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The licensee will review the Safe Sleep regulations and watch the Safe Sleep videos on https://safetosleep.nichd.nih.gov/resources/videos for Safe Sleep for Your Baby and all of the Safe Infant Sleep for Grandparents and Other Trusted Caregiver videos.
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The licensee did not ensure the pack-n-play was free from loose articles and objects. One infant was observed via video/photos asleep with a blue blanket and an iPad (prooped up) in the pack-n-play.
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The licensee will write a summary on each of the videos and submit to the LPA no later than 08/22/2023. The licensee will also write a plans to ensure the licensee and staff follow the safe sleep regulations.
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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: Cynthia Gray
LICENSING EVALUATOR NAME: Michelle Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5