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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 493009498
Report Date: 03/08/2023
Date Signed: 03/08/2023 01:19:54 PM

Unsubstantiated


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
11/22/2022 and conducted by Evaluator Amy Strother
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20221122113731
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: 9DATE:
03/08/2023
UNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Jackielyn BausleyTIME COMPLETED:
01:19 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Adult in home sexually abused day care child.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
A follow-up complaint investigation visit was made today by Licensing Program Analyst (LPA) Amy Strother to deliver complaint investigation findings. This complaint was investigated by the Department’s Investigations Branch (IB) Investigator, S. Guerra in collaboration with the Santa Rosa Police Department, Sonoma County Human Services Department Family Youth & Children’s Services and Redwood Children’s Center. It was alleged that an adult in home sexually abused day care child (C1). During the complaint investigation, interviews were conducted with licensee, staff, child (C1), and parents. A forensic interview was conducted with C1 and a physical examination of C1 by a medical professional was conducted. Based on available information, although the allegations may have happened or are valid, there is not a preponderance of evidence to support the allegation, therefore the allegation is unsubstantiated.
All licensing reports are public information and must be made available upon request for at least three years. This report was read and reviewed with the licensee, Jackielyn Bausley.
The Notice of Site Visit shall be posted for 30 days from today’s visit. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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