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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 394500459
Report Date: 11/19/2024
Date Signed: 11/19/2024 01:30:22 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. 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
08/05/2024 and conducted by Evaluator David Nguyen
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20240805145804
FACILITY NAME:WILLIAMS, JER'NEEFACILITY NUMBER:
394500459
ADMINISTRATOR:WILLIAMS, JER'NEEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 561-4869
CITY:STOCKTONSTATE: CAZIP CODE:
95219
CAPACITY:14CENSUS: 9DATE:
11/19/2024
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Williams, Jer'NeeTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Due to negligence, a child received an injury while in care.

INVESTIGATION FINDINGS:
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On November 19th, 2024, at 1:15 PM, Licensing Program Analyst (LPA) David Nguyen met with licensee, Jer’Nee Williams to deliver the findings of the complaint investigation regarding the above allegation. LPA was granted entry by licensee. There were nine (9) children present at the time of the visit. Licensee’s assistant/spouse was also present at the start of the visit.

It was alleged that “Due to negligence, a child received an injury while in care.” Investigator Juan Barajas from the Department’s Investigation Bureau (IB) conducted the investigation. During the investigation, IB conducted interviews with the reporting party, licensee, licensee’s assistant, daycare parents, and other parties, and obtained pertinent documents from the Stockton Police Department (PD). Based on the conflicting interviews, IB was unable to determine how the child’s injury occurred at the daycare facility nor when the child’s injury occurred.

Report continues on LIC9099-C....
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
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 53-CC-20240805145804
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: WILLIAMS, JER'NEE
FACILITY NUMBER: 394500459
VISIT DATE: 11/19/2024
NARRATIVE
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Based the statements from licensee’s, daycare parents’, and other parties’ interviews, and the conflicting information from reporting party, LPA David Nguyen determined that the complaint allegation was found to be UNSUBSTANTIATED, meaning 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 at the facility.

LPA discussed with licensee the appropriate cleaning procedures.

An exit interview was conducted and copy of this report was reviewed with licensee and provided to licensee, Jer’Nee Williams. 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: David Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
LIC9099 (FAS) - (06/04)
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