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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343624916
Report Date: 12/04/2025
Date Signed: 12/04/2025 03:43:09 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO 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
12/02/2025 and conducted by Evaluator Soleil Marx
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20251202134925
FACILITY NAME:MISSION AVENUE PRESCHOOLFACILITY NUMBER:
343624916
ADMINISTRATOR:NICOLE MORAN-ESTRADAFACILITY TYPE:
830
ADDRESS:2433 MISSION AVENUETELEPHONE:
(916) 487-4647
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:19CENSUS: 10DATE:
12/04/2025
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Nicole Moran-EstradaTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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9
Staff are not following safe sleep protocols with infant(s) in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marx met with Director,Nicole Moran-Estrada, for the purpose of delivering complaint findings for the above allegation. Throughout the investigation, LPA made observations, reviewed records, and conducted interviews. It was determined by interviews conducted with director and staff that an infant was swaddled in care on at least one occasion. It was determined by record review, that there are no sleep plans on-file. Based on record review and interviews in which were conducted, the perponderance of evidence standard has been met, therefore the above allegation that Staff are not following safe sleep protocols with infant(s) in care is found to be substantiated. Reporting requirements were discussed. Licensee was informed that this report dated 12/04/2025 documents one Type A citation which shall be posted for 30 consecutive days. The Licensee shall also provide a copy of this licensing report 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, report reviewed with Director, appeal rights provided. Notice of site visit given and must remain be posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025
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 03-CC-20251202134925
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: MISSION AVENUE PRESCHOOL
FACILITY NUMBER: 343624916
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/05/2025
Section Cited
CCR
101430(a)(3)(c)
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(C) An infant shall not be swaddled while in care.

This requirement was not met as evidenced by:
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Director stated staff who were involved in the incident, received disciplinary action in form of a write-up and all infant staff were re-trained on safe sleep regulations. Director stated swaddle sacks were removed from premises. LPA obtained POC documentation and POC was cleared by visit
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Based on interview, the licensee did not comply with the section cited above by swaddling an infant in care, which poses an immediate Health, Safety, or Personal Rights risk to perons 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: Seychelle De Luca
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 03-CC-20251202134925
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: MISSION AVENUE PRESCHOOL
FACILITY NUMBER: 343624916
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/11/2025
Section Cited
CCR
101419.2(b)(2)
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(2) Infants up to 12 months of age shall have a completed Individual Infant Sleeping Plan [LIC 9227 (3/20)],

This requirement was not met as evidenced by:
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Director stated she will have parent/guardians of infants under 12 months of age fill out a LIC9227 and keep it on file with the needs and service plans. Director will submit LIC9227 to LPA Marx once completed.
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Based on record review, the licensee did not comply with the section cited above by not having Infant Sleeping Plans on file for infants in care, which poses a potential Health, Safety, or Personal Rights risk to persons 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: Seychelle De Luca
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO 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
12/02/2025 and conducted by Evaluator Soleil Marx
COMPLAINT CONTROL NUMBER: 03-CC-20251202134925

FACILITY NAME:MISSION AVENUE PRESCHOOLFACILITY NUMBER:
343624916
ADMINISTRATOR:NICOLE MORAN-ESTRADAFACILITY TYPE:
830
ADDRESS:2433 MISSION AVENUETELEPHONE:
(916) 487-4647
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:19CENSUS: 10DATE:
12/04/2025
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Nicole Moran-EstradaTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
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3
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5
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7
8
9
Staff did not adequately supervise infant while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marx met with Director,Nicole Moran-Estrada, for the purpose of delivering complaint findings for the above allegation. LPA observed a census of 10 infants being supervised by four staff. Throughout the investigation, LPA made observations, reviewed records, and conducted interviews. LPA observed infants being supervised by staff. LPA observed classrooms were arranged to easily maintain visual supervision. LPA observed nap room set up meets the requirements for nap time supervision. Interviews conducted with staff had aligning statements that supervision is always maintained. Interviews conducted with parent/guardians did not reveal concerns regarding supervision. Based on LPAs observations, record review, and interviews in which were conducted; no pertinent evidence was obtained that would support the alleged violation. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the allegations, therefore the allegations are unsubstantiated. Exit interview conducted, report reviewed with Director, appeal rights provided. Notice of site visit given and must remain be posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4