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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073409607
Report Date: 08/23/2024
Date Signed: 08/23/2024 10:55:41 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/15/2024 and conducted by Evaluator Melissa Domantay
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20240815115105
FACILITY NAME:KIDS COUNTRY AT TASSAJARA HILLSFACILITY NUMBER:
073409607
ADMINISTRATOR:MATT MONTEMAYORFACILITY TYPE:
860
ADDRESS:4675 CAMINO TASSAJARATELEPHONE:
(925) 743-3192
CITY:DANVILLESTATE: CAZIP CODE:
94506
CAPACITY:255CENSUS: 0DATE:
08/23/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Matt MontemayorTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Unlicensed Care
INVESTIGATION FINDINGS:
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On 8/23/24, Licensing Program Analyst (LPA) M. Domantay conducted an unannounced complaint
investigation to open complaint, investigate, and deliver the findings. LPA met with Director, Matt Montemayor. LPA conducted staff interviews during today's inspection.

Based on the investigation it is determined that facility was providing unlicensed care to children before the pre-licensing inspection and approval of licensure.

See 9099-D for Type A citation.

Based on staff interviews obtained throughout the investigation, the preponderance of evidence standard has been met. Therefore, the allegation is SUBSTANTIATED. Exit interview conducted and Notice of Site Visit provided and must be posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024
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 02-CC-20240815115105
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: KIDS COUNTRY AT TASSAJARA HILLS
FACILITY NUMBER: 073409607
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/23/2024
Section Cited
HSC
1596.80
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No person, firm, partnership, association, or corporation shall operate, establish, manage, conduct, or maintain a child day care facility in this state without a current valid license, therefor as provided in this act.
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Facility currently has a pending application for child care license.
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This was not met as evidenced by staff interviews revealing that unlicensed care was being provided at above facility before the pre-licensing inspection and approval of licensure.
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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: Mai Lor
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024
LIC9099 (FAS) - (06/04)
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