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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 393601775
Report Date: 08/19/2025
Date Signed: 12/16/2025 10:35:33 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. 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
08/13/2025 and conducted by Evaluator Janie Davis
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20250813151814
FACILITY NAME:COUNTRY KIDS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
393601775
ADMINISTRATOR:DAWN BRIGGSFACILITY TYPE:
840
ADDRESS:1301 MILLER AVENUETELEPHONE:
(209) 838-1600
CITY:ESCALONSTATE: CAZIP CODE:
95320
CAPACITY:28CENSUS: 0DATE:
08/19/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Elizabeth LangumTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff did not keep the facility free of mold
INVESTIGATION FINDINGS:
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This is an amended version of the report dated 08/19/2025. Licensing Program Analyst (LPA) Janie Davis conducted an unannounced visit to open a complaint investigation for the above allegation. LPA met with facility representative Elizabeth Langum. LPA observed no children present in the school age program.
Throughout the course of the investigation, LPA conducted physical plant inspections, on-site observations, interviews, reviewed and collected documentation. It was alleged that the water from the fridge is molded. Althought the fridge was dirty, it could not be determined by LPA if it was molded.
Based on the conflicting information within interview and observations, throughout the course of this investigation, the above allegation could not be substantiated or dismissed. 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, therefore the finding is UNSUBSTANTIATED.
Exit interview was conducted. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Janie Davis
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2025
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 3
Control Number 53-CC-20250813151814
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: COUNTRY KIDS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 393601775
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
09/19/2025
Section Cited
CCR
101239.2
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(a)Drinking water from a noncontaminating fixture or container shall be readily available both indoors and in the outdoor activity area.
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Facility will provide proof of refrigerator water line being shut off by way of video by POC date. Or refrigerator will be completely replaced with proof of photo sent to LPA by POC date.
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As evidenced by accesible molded refrigerator water spout operable in facility kitchen.
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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: Chayntel Hunter
LICENSING EVALUATOR NAME: Janie Davis
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3