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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343624918
Report Date: 09/04/2025
Date Signed: 09/04/2025 11:37:59 AM

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
06/18/2025 and conducted by Evaluator Soleil Marx
COMPLAINT CONTROL NUMBER: 03-CC-20250618083107
FACILITY NAME:MISSION AVENUE PRESCHOOLFACILITY NUMBER:
343624918
ADMINISTRATOR:CHRISTINA DIAZ BUSHMANFACILITY TYPE:
840
ADDRESS:2433 MISSION AVENUETELEPHONE:
(916) 276-0279
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:18CENSUS: 0DATE:
09/04/2025
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Nicole Moran-EstradaTIME COMPLETED:
11:55 AM
ALLEGATION(S):
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Licensee did not prevent daycare child from sustaining a dog bite
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Marx and Williams met with Director,Nicole Moran-Estrada, for the purpose of delivering complaint findings for the above allegation. Throughout the investigation, LPA Velasco reviewed records and conducted interviews.The dog bite incident occurred on 03/27/2024 and was a self-reported by the facility which resulted in a case-management inspection that was conducted on 04/11/2024. It was determined by interview/incident report, that a child was bit on the nose by the maintence worker's dog that was brought on-site, which resulted in the child sustaining a minor injury and medical attention.Based on record review and interviews in which were conducted, the perponderance of evidence standard has been met, therefore the above allegation is found to be substantiated..Licensee was informed that this report dated 09/04/2025 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. Licensee has been provided with appeal rights.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: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
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 2
Control Number 03-CC-20250618083107
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: 343624918
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/05/2025
Section Cited
CCR
101223(a)(2)
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101223 Personal Rights



(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 was not met as evidenced by
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Director stated since the incident occurred, the dog has not been allowed on site and Director stated that dogs are no longer permitted on the premises. Deficiency cleared by visit
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Based on record review and interview, the licensee did not comply with the section cited above by a child sustaining a dog bite injury on the school premises, which poses an immediate health, safety, and/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: 09/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
LIC9099 (FAS) - (06/04)
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