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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 493009498
Report Date: 08/11/2022
Date Signed: 08/11/2022 10:44:15 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/16/2022 and conducted by Evaluator Amy Strother
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20220516132419
FACILITY NAME:BAUSLEY, JACKIELYN FCCHFACILITY NUMBER:
493009498
ADMINISTRATOR:BAUSLEY, JACKIELYNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 888-5130
CITY:SANTA ROSASTATE: CAZIP CODE:
95407
CAPACITY:14CENSUS: DATE:
08/11/2022
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Jackielyn BausleyTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Children in care were inappropriately disciplined by adult in the home.

Licensee used highchair as a restraint device for children in care.
INVESTIGATION FINDINGS:
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A subsequent complaint investigation inspection was conducted at the facility by Licensing Program Analyst (LPA), Amy Strother to deliver complaint investigation findings. LPA met with Licensee Jackielyn Bausley. It has been alleged that children in care were inappropriately disciplined by adult in the home. It has also been alleged that Licensee used highchair as a restraint device for children in care.
During the initial investigation visit on 05/25/22, LPA requested and received a current roster of children in care, interviewed the Licensee (L1) and two assistance, Adult 3 and Adult 4 (A3 & A4). On 05/25/22 at 3:29pm, Licensee (L1) confirmed that highchairs are used as a form of discipline for children over three or four years old, stating that on more then one occasion, children have been placed in a highchair with the tray attached for 10-15 minutes, due to unwanted behavior. L1 stated during the interview that no other forms of discipline are used by herself or her assistants.
LPA conducted interviews with two children (C1 & C2) and 5 adults, Adult 1 – 4 and Adult 7 (A1 – A4 & A7) between 05/24/22 and 07/8/22.
Continue on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022
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 01-CC-20220516132419
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: BAUSLEY, JACKIELYN FCCH
FACILITY NUMBER: 493009498
VISIT DATE: 08/11/2022
NARRATIVE
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Statements provided by C1, C2, A3 and A4 confirm that on more than one occasion a child or children have been restrained in a highchair as a form of discipline. C1 stated that they are put in a baby highchair to get calm. C2 stated that they must sit in the highchair when they get in trouble. A3 and A4 stated when children are fighting with each other they are put in a highchair to separate them. A3 further stated that the seatbelt on the highchair is used to keep the child in or a playpen in the backyard has been used to separate children.

During an interview with C1, C1 stated additional examples of discipline used by an adult in the home. C1 stated that on an unspecified date, an adult in the home (A3) threw a water bottle at their head and it hurt. Additionally, C1 stated that A3 hit them with their blanket when they tried to grab their blanket back from A3, and it hurt and that A3 looked right at them and put soap in their eyes during a bath. Adults interviewed reported that C1 has spontaneously reported A3’s inappropriate discipline to them on separate occasions, disclosing that A3 threw a water bottle or water cup at their head while in care and put soap in their eyes and laughed about it.

Based on interviews, the preponderance of evidence standard had been met. Interviews with L1, C1, C2, A3 and A4 corroborate that on more than one occasion a highchair was used as a restraint device for children in care. Interviews with C1, and spontaneous disclosures to A2 and A7 by C1, corroborate that a child (C1) was inappropriately disciplined by adult (A3) in the home. Based on interviews conducted the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. California Code of Regulations, Title 22, are being cited on the attached LIC 9099-D. Appeal Rights were provided.


LPA Strother informed licensee Jackielyn Bausley that this report dated 08/11/22 documents two Type A citations which shall be posted for 30 consecutive days as there are immediate risks to the health, safety, and personal rights of children in care.

Also, LPA Strother informed the licensee to provide a copy of this licensing report dated 08/11/22, that documents a Type A citations 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 and report was reviewed with License, Jackielyn Bausley. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 01-CC-20220516132419
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: BAUSLEY, JACKIELYN FCCH
FACILITY NUMBER: 493009498
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/11/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/12/2022
Section Cited
CCR
102423(a)(4)
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(a)Each child receiving services from a family child care home shall have certain rights that shall not be waived...not limited to, the following:(4)To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature...
This requirement was not met as evidenced by:
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Licensee and assistants will sign a statement that they have read and understand the Personal Rights Title 22 Regulations and will sign a statement agreeing to complete a training and train staff on the following: Personal Rights, Trauma Informed Care and Self-Care using the following materials provided in an email from LPA Strother:
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Based on interviews A3 hit C1 with a water bottle and a blanket while in care which poses an immediate Health, Safety or Personal Rights risk to children in care.
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Videos: Children’s Personal Rights in Child Care, Trauma, Brain and Relationship: Helping Children Heal, The "life-changing" story Oprah reports this week, Child Development Core Story, Part 2: Serve and Return and Self Care: What It Really Is. Read & Review: Child Trauma Toolkit for Educators. Read, Review & Do: Early Childhood Mental Health Consultation – Taking Care of Ourselves
Once training has been completed by 08/12/22, submit a photo of a signed and dated statement that you and your assistants have been trained on Personal Rights, Trauma Informed Care and Self-Care concepts.

Type A
08/12/2022
Section Cited
CCR
102423(a)(2)
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(a)Each child receiving services from a family child care home shall have certain rights that shall not be waived... These rights include, but are not limited to,...:(2)To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
This requirement was not met as evidenced by:
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Same as above.
Additonally Licensee is reducing the facilities hours of operation and will submit an updated LIC279, with the purpose of reducing providers stress level.
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Based on interviews the Licensee and assistants restrained children to a highchair as a form of disipline on more than one occasion, which poses an immediate Health, Safety or Personal Rights risk to children 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: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3