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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 393621392
Report Date: 09/27/2022
Date Signed: 09/27/2022 11:55:51 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 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
09/01/2022 and conducted by Evaluator Lauren Scott
COMPLAINT CONTROL NUMBER: 53-CC-20220901085228
FACILITY NAME:MOODY, DOLORISFACILITY NUMBER:
393621392
ADMINISTRATOR:MOODY, DOLORISFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 992-9294
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY:14CENSUS: 3DATE:
09/27/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:licensee, Doloris MoodyTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Provider left daycare child with uncleared adult.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Lauren Scott and Tiffanie Diep met with Licensee, Doloris Moody to deliver the findings of the complaint investigation regarding the above allegation.

During the course of the investigation, LPA Scott conducted interviews, and obtained information pertaining to allegation. It was alleged that the licensee left for a medical appointment while caring for at least one child. Before licensee left, she brought the child (C1) to a neighbor’s house, for the neighbor to care for the child. Although the neighbor operated a licensed daycare facility and is fingerprint/ background cleared, the individual is not associated to the licensee’s facility and is not listed as a relocation site on the Licensee’s Emergency Disaster Plan.

Based on a preponderance of evidence obtained the complaint regarding the above allegation was SUBSTANTIATED. Title 22 regulations are being cited on the attached 9099-D page.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
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
Control Number 53-CC-20220901085228
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: MOODY, DOLORIS
FACILITY NUMBER: 393621392
VISIT DATE: 09/27/2022
NARRATIVE
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An exit interview was conducted with the Licensee. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

LPA Scott informed licensee Doloris Moody, that this report dated September 27, 2022 documents one Type A citation. Type A citations shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Scott informed the licensee that she must provide a copy of this licensing report dated September 27, 2022, that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 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
09/01/2022 and conducted by Evaluator Lauren Scott
COMPLAINT CONTROL NUMBER: 53-CC-20220901085228

FACILITY NAME:MOODY, DOLORISFACILITY NUMBER:
393621392
ADMINISTRATOR:MOODY, DOLORISFACILITY TYPE:
810
ADDRESS:717 FARGO STREETTELEPHONE:
(209) 992-9294
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY:14CENSUS: 3DATE:
09/27/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:licensee, Doloris MoodyTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Provider left daycare children unattended and crying for an extended period of time.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Lauren Scott met with licensee Doloris Moody to deliver the findings of the complaint investigation regarding the above allegation.

During the course of the investigation, LPA Scott conducted interviews, and obtained information pertaining to allegation. It was alleged that the licensee was leaving children unattended for extended periods of time, resulting in crying. Through interviews, it was learned the provider does go into the kitchen to cook for children, while they remain in the daycare room. But provider is able to hear the children and is able to attend to them as needed. LPA Scott discussed Title 22 regulations and supervision in Family Child Care Homes.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
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 53-CC-20220901085228
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: MOODY, DOLORIS
FACILITY NUMBER: 393621392
VISIT DATE: 09/27/2022
NARRATIVE
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Based on the information obtained throughout the course of this investigation, the above allegation could not be substantiated or dismissed. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the finding is UNSUBSTANTIATED.

Exit interview was conducted. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 53-CC-20220901085228
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: MOODY, DOLORIS
FACILITY NUMBER: 393621392
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/27/2022
Section Cited
CCR
102370(d)(2)
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102370 Criminal Record Clearance (d) All individuals subject to a criminal record review... prior to working, residing, or volunterring in a licensed facility.
(2) Request a transfer of a criminal record clearance...
This requirement was not as evidenced by:
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Licensee will associate this individual to her facility and ensure criminal background check is verified. Also, Licensee will add this individual's home as a relocation site on the Emergency Disaster Plan.
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On August 31, 2022, licensee stated she had a dental emergency and had to leave the facility. Licensee stated she brought one daycare child to a nearby licensee (A1) for care. Upon review, it was determined A1 is not associated to this facility.
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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: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5