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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 394500999
Report Date: 12/10/2025
Date Signed: 12/10/2025 10:58:15 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 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
10/08/2025 and conducted by Evaluator Stacey Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20251008085834
FACILITY NAME:DOUGLASS, KATHERYNE & GOMEZ, KARENFACILITY NUMBER:
394500999
ADMINISTRATOR:DOUGLASS, KATHERYNEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 513-0576
CITY:STOCKTONSTATE: CAZIP CODE:
95215
CAPACITY:14CENSUS: 0DATE:
12/10/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Katheryne Douglass TIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Licensee does not ensure that staff have criminal clearance
Licensee does not maintain the facility free from hazards
Licensee does not maintain facility sanitary
Licensee does not maintain facility in good repair
Licensee does not maintain exits free from obstruction

INVESTIGATION FINDINGS:
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On December 10, 2025, Licensing Program Manager, Bettina Engelman and Licensing Program Analyst (LPA) Stacey Williams met with Licensee, Katheryne Douglass for the purpose of delivering complaint findings. There were no children present during the inspection.

An investigation was conducted regarding the allegations listed above. The facility was toured; interviews were conducted with the Reporting Party, Licensee, and witness of the alleged events. Licensee acknowledged that S1 was in the facility working the day an incident occurred involving a child who experienced an episode of erratic behavior. S1 assisted in providing care and supervision for children on that day. S1 did not have a fingerprint clearance on file while working in the facility. Licensee acknowledged not verifying that S1 was fingerprint cleared prior to working in the facility. Licensee stated that she intended on S1 reviewing paperwork the day of the incident, however due to a child’s outburst she needed assistance with the children.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2025
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 4
Control Number 53-CC-20251008085834
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: DOUGLASS, KATHERYNE & GOMEZ, KAREN
FACILITY NUMBER: 394500999
VISIT DATE: 12/10/2025
NARRATIVE
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Law enforcement, who were called to the facility on October 8, 2025, reported extensive clutter and furniture obstructing windows and doors. The licensee’s dog also snapped at the officer, biting their pants. When LPA inspected the facility on 10/14/2025, she observed the home to be in despair. There was excessive clutter throughout the home including the front door entry area, daycare activity areas and areas accessible to children in care. Upon entering the home, LPA observed the front door did not have a secure locking mechanism. There was also observation of dog feces and urine in an enclosed napping area. LPA observed minimal walkthrough space near the front door due to cabinets clustered together to prevent children from leaving. This area is also used as a main exit of the home. LPA observed excessive debris throughout the home on the floors and counters. There were hazardous objects covering the floors and furniture.

Based on the information received, and observation, a preponderance of evidence has been met.

LPA Williams informed licensee Kathryne Douglass that this report dated 12/10/2025 documents two Type-A citations which shall be posted for 30 consecutive days as there is/are immediate risks to the health, safety, or personal rights of children in care.



Based on the information received, and observation, a preponderance of evidence has been met.

LPA Williams informed licensee Kathryne Douglass that this report dated 12/10/2025 document(s) (number of Type A citation) Type-A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Williams informed the licensee to provide a copy of this licensing report dated 12/10/2025 that documents any Type-A citation(s) 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.


Exit interview conducted and report was reviewed with licensee, Katheryne Douglass.
A notice of site visit was given to licensee, Katheryne Douglass and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 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
10/08/2025 and conducted by Evaluator Stacey Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20251008085834

FACILITY NAME:DOUGLASS, KATHERYNE & GOMEZ, KARENFACILITY NUMBER:
394500999
ADMINISTRATOR:DOUGLASS, KATHERYNEFACILITY TYPE:
810
ADDRESS:3741 TINA PLACETELEPHONE:
(209) 513-0576
CITY:STOCKTONSTATE: CAZIP CODE:
95215
CAPACITY:14CENSUS: 0DATE:
12/10/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Katheryne DouglassTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Licensee fed infant another infants breast milk
INVESTIGATION FINDINGS:
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On December 10, 2025, Licensing Program Manager, Bettina Engelman and Licensing Program Analyst (LPA) Stacey Williams met with Licensee, Katheryne Douglass for the purpose of delivering complaint findings. There were no children present in the home.
An investigation was conducted regarding the allegation listed above. The facility was toured; interviews were conducted with the Reporting Party. It was alleged that Licensee fed an infant another infant’s breast milk. Licensee denied the allegation.
Inconsistent statements were received during the course of the investigation. Based on the information received, the allegation is determined to be unsubstantiated. 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.
Exit interview conducted at which time the report was reviewed with Licensee, Katheryne Douglass. A notice of site visit was given to licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 53-CC-20251008085834
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: DOUGLASS, KATHERYNE & GOMEZ, KAREN
FACILITY NUMBER: 394500999
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/11/2025
Section Cited
CCR
102370(d)(1)
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All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:
(1) Obtain a California clearance or a criminal record exemption as required by the Department
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Licensee states that she will ensure that ll employees will be fingerprinted and background checked before start date. Licensee states she will review department website for refresher trainings. Licensee will provide CCL a written statement indicating the above actions by plan of correction date.
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This requirement was not met as evidenced by:
Licensee did not ensure that staff had a fingerprint clearance prior to working in the home. Staff provided care and supervision for a child in the facility for one working day. This is an immediate risk to the health and safety of children in care.
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Type A
12/11/2025
Section Cited
CCR
102417(g)
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The home shall be free from defects or conditions which might endanger a child.
This requirement was not met as evidenced by:
Licensee’s home had excessive clutter and debris which has the potential to cause safety hazards.
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Licensee states that she will immediately de-clutter and sanitize the home. Licensee states that she will utilize a cleaning checklist daily to ensure the day-care areas of the home are clean and sanitized. Licensee will provide a copy of the checklist and photos of the home by plan of correction date.
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There were areas of the home with unsanitary conditions due to dirt, clutter and dog feces. Licensee’s dog bit the pants of a law enforcement officer on 10/8/2025. This is an immediate risk to the health and safety of children 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: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4