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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 394500974
Report Date: 05/07/2026
Date Signed: 05/07/2026 11:26:43 AM

Substantiated


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
02/06/2026 and conducted by Evaluator Deborah Khashe
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20260206101019
FACILITY NAME:KOALA TREE MONTESSORIFACILITY NUMBER:
394500974
ADMINISTRATOR:LEIDY PAOLA JACKFACILITY TYPE:
850
ADDRESS:2057 E. MAIN STTELEPHONE:
(209) 888-9048
CITY:STOCKTONSTATE: CAZIP CODE:
95205
CAPACITY:22CENSUS: 20DATE:
05/07/2026
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Leidy JackTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Staff did not ensure hazards were inaccessible to children in care.
INVESTIGATION FINDINGS:
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On May 7, 2026, Licensing Program Analysts (LPAs) Deborah Khashe and David Nguyen conducted an unannounced visit for the purpose to deliver complaint findings. The purpose of the visit was explained to the Facility Representative Paola Jack. During today’s visit there were twenty ( 20) children present with three (3) staff present.
It was alleged that staff did not ensure that hazards were inaccessible to children in care. On 11/10/2025 a child knelt in a droplet of bleach. Staff changed child’s pants and made the child wash hand even though the child did not touch any bleach. Licensing Program Analysts Deborah Khashe and Jennie Tedlos conducted classroom observations, interviewed the Director and teacher. LPA Khashe interviewed reporting party. LPA Khashe obtained email correspondence between the Facility Representative Paola Jack and the Reporting Party.

Report Continues on LIC9099C...(Page 2 )
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Deborah Khashe
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026
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 53-CC-20260206101019
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: KOALA TREE MONTESSORI
FACILITY NUMBER: 394500974
VISIT DATE: 05/07/2026
NARRATIVE
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Based on the information from the interviews conducted. LPA was able to determine that staff did not ensure hazards were inaccessible to children in care.

Based on the information obtained during the investigation the evidence standard has been met; therefore the above allegation is found to be SUBSTANTIATED.

An exit interview was conducted in which appeal rights were provided and a copy of this report was provided and reviewed with the Facility Representative, Leidy Jack . 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.

Deficiency is being cited on the subsequent 9099-D page.

SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Deborah Khashe
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 53-CC-20260206101019
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: KOALA TREE MONTESSORI
FACILITY NUMBER: 394500974
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/07/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/05/2026
Section Cited
CCR
101223(a)(2)
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(a) The licensee shall ensure that each child is accorded the following personal rights:

(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
This requirement is not met as evidence by:
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Facility Representative, Leidy Jack will provide training and information regarding safe cleaning practices in a Child Care Center. Leidy Jack will provide sign in sheet and agenda of what was talked about to LPA Khashe by POC date.
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Based on staff interview and record review. Licensee did not meet the requirments by having C1 exposed to bleach.
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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: Karyn Guerra
LICENSING EVALUATOR NAME: Deborah Khashe
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3