073409607-1-14-2026-02-CC-MPRE-DQBU2T-20260114141229

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073409607
Report Date: 01/14/2026
Date Signed: 01/14/2026 02:12:34 PM

Document Has Been Signed on 01/14/2026 02:12 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	KIDS COUNTRY AT TASSAJARA HILLS		FACILITY NUMBER:	073409607
ADMINISTRATOR/ DIRECTOR:	MATT MONTEMAYOR		FACILITY TYPE:	860
ADDRESS:	4675 CAMINO TASSAJARA		TELEPHONE:	(925) 743-3192
CITY:	DANVILLE	STATE: CA	ZIP CODE:	94506
CAPACITY: 255	TOTAL ENROLLED CHILDREN: 131	CENSUS: 42	DATE:	01/14/2026
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:35 AM
MET WITH:	Matt Montemayor		TIME VISIT/ INSPECTION COMPLETED:	02:09 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 1/14/2026 at 9:35am Licensing Program Analyst (LPA) Morgan Pringle met with director Matt Montemayor for a case management visit to follow upon on an unusual incident that was self reported by the facility stating it had been alleged a child was hit by a staff member. Present during LPAs visit were seven (7) additional staff and forty-two (42) school age children arrived around 11:45am. The facility operates from 6:30am - 6:30pm, Monday - Friday. An unusual incident was received on 12/29/2025 stating that the facility received an email from P1 on 12/23/2025 stating that C1 stated S1 had hit them while at school. HR was made aware of the allegation and an internal investigation would be conducted. There were about ten(10) school age children and six staff present in the room that day. LPA interviewed staff and was informed that on 12/23/2025 S1 was informed by another child about C1's behavior during play time at the Lego table. S1 went over to C1 and spoke with them at the brown rug about the reported behavior. S1 let C1 know that the behavior displayed was not appropriate and C1 agreed. C1 went back to play at the Lego table and S1 went back to supervising the children. A meeting was had with P1 and C1 on 1/13/2026 and C1 stated that S1 hit them on the arm, but it may have been an accident or it was S1's walkie-talkie that hit them. C1 stated they are not scared of S1, they feel safe at school, they were not hurt and that S1 did not yell at them. S2 also stated, "I saw no physical contact whatsoever between S1 and C1." Through LPAs interviews conducted and documents collected there is no evidence to prove S1 hit C1. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with director Matt Montemayor.

NAME OF LICENSING PROGRAM MANAGER: Jason Jang
NAME OF LICENSING PROGRAM ANALYST: Morgan Pringle
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/14/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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