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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 493009498
Report Date: 03/12/2026
Date Signed: 03/12/2026 11:39:57 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC RO, 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
12/19/2025 and conducted by Evaluator Amy Strother
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20251219162844
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: 3DATE:
03/12/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jackielyn BausleyTIME COMPLETED:
11:40 AM
ALLEGATION(S):
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Uncleared adult is providing care and supervision to children in care.
Licensee is not present at the daycare for 80 percent of the hours of care.
Licensee is operating over capacity.
Staff handle daycare children in a rough manner.
Licensee inappropriately restrains daycare children.
Licensee did not report unusual incidents.
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 (L1). The compliant alleged the following allegations: 1) An uncleared adult is providing care and supervision to children in care; specifically, that the licensee’s father has been providing care and supervision to the children, despite not having a background check. 2) Licensee is not present at the daycare for 80 percent of the hours of care; specifically, that the licensee frequently travels out of the country, leaving the children in the care of her assistants. 3) Licensee is operating over capacity; specifically, that the licensee hides children during licensing inspections by placing them in the upstairs bedrooms. 4) Staff handle daycare children in a rough manner; specifically, staff have been observed “yanking” children by their arms. 5) Licensee inappropriately restrains daycare children; specifically, staff are confining children to high chairs or swings for extended periods. 6) Licensee did not report unusual incidents, specifically, there have been incidents in which parents who “reeked of alcohol” were allowed to leave the facility with their children, and that the licensee failed to report these incidents to the appropriate authorities. (Continue on LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melchisedeck Augustin
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026
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 14
Control Number 01-CC-20251219162844
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: BAUSLEY, JACKIELYN FCCH
FACILITY NUMBER: 493009498
VISIT DATE: 03/12/2026
NARRATIVE
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PAGE 2
During the initial investigation visit on 12/29/25 at 4:09pm, LPA met with two assistants, S1 and S2 who were observed supervising 11 children. Ten minutes into the visit, Licensee (L1) arrived home. LPA requested that L1 review a roster obtained by LPA on 10/30/25 and update it as necessary. L1 added “date left” dates to five children on the roster. LPA conducted interviews with one child (C1) and the Licensee (L1).

LPA conducted interviews between 02/04/26 and 03/09/26 with 10 adults, Adult 1 – Adult 8 (A1-A8) who were a combination of parents of formerly or currently enrolled children or staff from the elementary school L1 does school pick-ups from, and Staff 1 - Staff 3 (S1-S3) who are assistants at the Family Child Care Home facility. LPA conducted interviews with 2 additional children, Child 2 & Child 3 (C2 & C3) on 03/06/26 and 03/09/26.

Interviews with L1, S1 & S2, and A1, A4, A5, A6 and A7 corroborated that 4 adults live in the home. A review of the Facility Roster on the Guardian site on 12/22/25 and 03/11/26 confirms that the four adults living in the home, including L1’s father, have an eligible clearance associated with the facility.

During an interview with S3 on 03/09/26, S3 stated that in addition to helping the Licensee out and caring for children in S3’s own home, S3 has helped the Licensee on at least two occasions in the Licensee’s home, working with assistant S1, caring for 6 or 7 children. S3 stated the first time was in October or November, and could not remember when the second time was, but stated it was for the purpose of the Licensee working at a property she purchased with plans of opening a Child Care Center.

LPA’s review of the Facility Roster from the Guardian site on 12/22/25 and 03/11/26 confirms that S3 does not have a criminal record clearance associated to the facility. LPA conducted a name search in Guardian with the name given by S3. S3 does not have an eligible clearance in the Guardian system and provided care and supervision to children in L1’s licensed home.

LPA’s file review of the most current application, form LIC279 on file, dated 11/25/24 by the Licensee, lists the licensee’s days and hours of operation as Monday through Sunday, 12:01am to 11:59pm. This implies that the facility is open 24 hours a day, 7 days a week, allowing the Licensee to be absent from the facility no more than 4.8 hours per day.

Continue on LIC9099-C
SUPERVISORS NAME: Melchisedeck Augustin
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 14
Control Number 01-CC-20251219162844
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: BAUSLEY, JACKIELYN FCCH
FACILITY NUMBER: 493009498
VISIT DATE: 03/12/2026
NARRATIVE
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PAGE 3
Based on interview with L1 on 12/29/25, L1 is currently operating from 5:00am through 12:00am, based on current family’s needs. The current hours equal 19 hours open, allowing for the Licensee to be absent from the facility no more than 3.8 hours per day.

On 12/29/25 L1 stated that she did leave four children in the care of assistants S1 and S2 while away on an international trip from 10/09/25 to 10/13/25. L1 declined for LPA to review her passport to confirm dates that L1 was out of the country.

On 03/06/25 S1 and S2 corroborated that they cared for children while L1 was out of the country, stating it was for just two days in October 2025. S2 gave a break down of L1’s daily schedule, first stating that L1 leaves the home to take children to school at 8:00am, then later changing it to 7:30am and returns between 9:00am and 10:00am. S2 shared that L1 then leaves the home for school pick up at 2:00pm and returns to the home by 4:00pm. Based on LPA’s calculations, L1 is absent from the home for up to 4.5 hours on a regular basis. S2 stated during the interview that L1 is upstairs when home, preparing documents or she is downstairs.

S2 informed LPA Strother during the interview that L1 is preparing to open a preschool and is at the preschool location on Saturdays and Sundays, joined by S2 to help with preparations. S2 first stated that there are no children present at the Family Child Care Home (FCCH) on Saturday and Sunday. S2 later stated that there are times that one child comes to the FCCH around 1:30pm or 2:30pm on the weekends, stating that in the morning there are no children, only one or two children in the afternoon. S2 stated that it is assistant S1 that cares for those one or two children.

A1 stated during the 02/04/26 interview that they were informed that L1 would be out of the country in September or October and asked if they would help take care some of the children, while S1 and S2 also cared for some of the children. A1 stated that they believe that L1 has traveled out of the country while S1 and S2 cared for the children 5 to 6 times between 2019 and 2025.

Continue LIC9099-C
SUPERVISORS NAME: Melchisedeck Augustin
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 14
Control Number 01-CC-20251219162844
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: BAUSLEY, JACKIELYN FCCH
FACILITY NUMBER: 493009498
VISIT DATE: 03/12/2026
NARRATIVE
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PAGE 4
During interviews conducted on 03/03/26 with A4-A8, A4 stated that S1 and S2 are the main care takers of the children, stating that L1 needs to do other things like prepare food or leave home to drive somewhere. A4 did not have knowledge of where L1 was driving to when leaving the home. A5 stated that L1 is home when they drop off or pick up their children.

A6 stated that L1 was not home when they dropped off their child(ren), stating that it was usually S1 and S2 that were home, but that L1 was usually there at pick up time. A6 was not aware of where L1 was when she was not home. A6 stated that they recall two occasions that L1 was going to be out of the country and their children were either cared for by S1 and S2 or by the parent of one of the children from day care. A6 added that their oldest child told them that L1 is not home on the weekends when they are in care.

A7 stated that they believed that L1 was caring for their child, along with assistants S1 and S2. A7 stated that L1 recently let them know that she would not be there and that S1 and S2 would be there. A7 stated that she was able to get her children to care with the help of a friend picking them up from school and taking them to L1’s home to be cared for by S1 and S2, stating they think it was in November. A8 had no information about L1 not being present to care for the children.

During interviews with children, C1 stated that L1 is either upstairs when she is home or in the room near the kitchen and that S1 and S2 take care of the children. C2 stated that S1 and S2 took care of them and that L1 was not home, stating they didn’t know where L1 was. C3 stated that L1 takes care of the people that take care of the children, S1 and S2, and that L1 also takes care of her own children.

During the interview on 12/29/25, L1 admitted that she has had too many children. L1 stated specifically that she has taken children on days when she had too many. L1 stated that once a month since August 2025 she takes some children to the park, leaving them there with her husband and her own two children. L1 stated that her husband would meet her at the park and stay there with the children, then L1 would return to the park to get children and bring them to the house before they were due for pick up, then go back for the others when the numbers of children reduced at the house. L1 denied that any children ever went upstairs.

Continue on LIC9099-C
SUPERVISORS NAME: Melchisedeck Augustin
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 14
Control Number 01-CC-20251219162844
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: BAUSLEY, JACKIELYN FCCH
FACILITY NUMBER: 493009498
VISIT DATE: 03/12/2026
NARRATIVE
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PAGE 5
On 03/06/26 S1 and S2 both stated that they understand the maximum number of children is 14 and that they have not had too many children. S1 and S2 denied having any knowledge of L1’s husband keeping children at the park, and denied that any day care children have been in the upstairs area of the home.

During an interview with A1 on 02/04/26, A1 stated that their child told them that the Licensee (L1) let them go upstairs into L1’s child’s room. A1 stated that it was a big deal because her child told them more than once, talking about getting to color in L1’s child’s room. A1 figured it was special because upstairs was always off-limits.

Based on a review of records received by the Department on 12/19/25, A1 stated that when a Licensing inspector arrives, the provider instructs them to keep their child home or hides children in an upstairs bedroom to avoid being cited for being over capacity.

On 03/06/26 LPA interviewed child (C2). During the interview C2 asked LPA, "Can I tell you something else?" and spontaneously offered the following information in summary: One time I was going to sleep, there was a couch and I had a blanket that I liked to use. I went to sleep on the couch in the room where the kids play. I woke up to someone taking me to a room in the house upstairs. I woke up on a bed. I woke up and went to another room, and I found other kids. The kids were upstairs because there were inspectors for daycare and Jackie wasn’t there and they told me we couldn’t go down there because Jackie would lose her license. The rest of the kids were in Jackie’s bedroom. Jackie’s child told me to be quiet. It was her younger child that told me. After the inspector left we went downstairs. It was at least 30 minutes to an hour and 30 minutes.

On 03/09/26 LPA interviewed child (C3), when asked if C3 remembered a time that they went upstairs, C3 stated that they never went upstairs in Ms. Jackie’s house. C3 informed LPA that teacher Jackie’s kids’ room are upstairs.

During interviews with L1, S1 and S2 they all denied ever handling the children roughly, stating they do not pull on the children. S1 and S2 stated that they use time outs for disciplining the children.

Continue on LIC9099-C
SUPERVISORS NAME: Melchisedeck Augustin
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 14
Control Number 01-CC-20251219162844
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: BAUSLEY, JACKIELYN FCCH
FACILITY NUMBER: 493009498
VISIT DATE: 03/12/2026
NARRATIVE
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PAGE 6
On 02/04/26 A1 stated that they observed S1 and S2 get upset with two different children: grabbing the children and dragging them over to the couch or putting them in the play pen/portable crib. A1 was unable to name one of the children, identifying the other child as (C4).

During interviews conducted with A4 – A8 on 03/03/26, A4 stated they have not seen children in care disciplined other than telling the children to calm down in a firm voice. A5 stated they have never witnessed an adult pull on a child’s arm and doesn’t have any concerns about the safety of their child while in care.

A6 stated that their child reported to them that they had been hit while in care on two separate occasions. A6 recalls their child stating specifically that S1 smacked them on the arm after they spilled another child’s food while “messing around”. The second time their child stated that they were in the living room and were told to sit down, did not listen, and was smacked in the leg by S1 while told again to sit down.

A6 stated that they had never personally seen any staff pull on children, but that their child did share that they saw S2 pull on A4’s arm, pick A4 up by the arm and grab A4’s arm really hard. A7 and A8 had no knowledge of staff handling children in a rough manner.

During interviews with children, C2 informed LPA that there was a child (C4), who was four year old and got spanked two times. One time it was S2 and one time it was S1 that spanked C4. C2 stated it made them feel bad and they told their parent. C2 spontaneously shared that when S1 and S2 spank kids they do it with a sandal, not with their hand.

C2 stated that they know that they were hit two times, “just in general of being there”, but don’t really remember, and know that they told their parent about it. C2 then stated that they remember getting hit because they needed to charge their tablet and the only place to plug in was where diapers were changed. C2 described trying to climb over a child getting their diaper changed to plug the tablet in and getting hit. C2 stated they couldn’t remember if it was S1 or S2 that hit them, that they were hit with the inside of a hand and it sort of hurt and sort of didn’t.

Continue on LIC9099-C
SUPERVISORS NAME: Melchisedeck Augustin
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 14
Control Number 01-CC-20251219162844
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: BAUSLEY, JACKIELYN FCCH
FACILITY NUMBER: 493009498
VISIT DATE: 03/12/2026
NARRATIVE
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PAGE 7
C3 stated during interview that whenever children do things that S1 thinks are bad, S1 says she’s going to call the police on them. C3 shared that S1 and S2 spank little kids, stating that spanking is not hard; it’s like a little spanking that would make them cry. C3 stated kids would get a spanking from S1 and S2 when they aren’t going to sleep or when they are hungry and are trying to get food. C3 described a spanking as using the “whole palm”, only the hand. C3 continued, stating that some children bite and scratch S1 and S2 or other kids; when this happens S1 and S2 just stop them or they "pop them, hit them, that is what pop is." C3 stated that they have different names for hitting. C3 spontaneously, stated that popping is the same thing as spanking, it’s on the butt and the mouth.

L1 stated that they don’t have swings and highchairs anymore, not since past incidents. S1 stated that they don’t have highchairs anymore and aren’t using swings anymore. S2 stated that they don’t use cribs to separate the children, just to put the children in to go to sleep, patting their legs so they can sleep.

A1 stated as described above that they have observed S1 and S2 get upset with two different children: grabbing the children and dragging them over to the couch or putting them in the play pen/portable crib.

A4 stated they have only seen the play yards used for children to sleep, not for discipline and have not seen highchairs or baby swings in the living room. A5 stated they haven’t seen equipment used for discipline and have never seen play pens, highchairs, or swings for time outs or anything, stating they don’t know what they do for discipline.

A6 stated that one day they arrived to pick up and observed their mobile 2 year old in a baby saucer, stating that S1 and S2 told them that the child had just climbed in there, while laughing about it. A6 stated that she took their word for it but isn’t sure if it was used to restrain the child or not.

A7 stated that they didn’t know how discipline was handled but has not seen the highchairs or play pens used for a time out or for any discipline and that their child has never mentioned anything to them. A8 stated they had no knowledge of a play pen or highchair being used for their 4 year old child.

Continue on LIC9099-C
SUPERVISORS NAME: Melchisedeck Augustin
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026
LIC9099 (FAS) - (06/04)
Page: 7 of 14
Control Number 01-CC-20251219162844
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: BAUSLEY, JACKIELYN FCCH
FACILITY NUMBER: 493009498
VISIT DATE: 03/12/2026
NARRATIVE
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PAGE 8
During interviews with children, C1 stated that they see kids pulling kids and Jackie's child pulling on kids. C1 stated that they don't see adults pull on kids, but that S1 puts kids to bed, in the little cribs, if C1 pulls on kids, and tells C1 nothing. C2 stated whenever C4 did something C4 always had to be put in a crib, stating it was because C4 ran around and was loud. C3 stated when C4 is doing something, C4 is not supposed to do, C4 goes in the crib as a punishment, so C4 doesn’t get out and hurt kids.

During the investigation there was no corroborating evidence to prove that children have been inappropriately restrained in highchairs since the facility was cited on 08/11/22 for the same allegation, see complaint control number 01-CC-20220516132419. However, there was corroborating evidence that a child (A4) was observed to be placed in a portable crib as a method of separating the child from others. A4 was age 3 years at the time of enrollment, and beyond the age of using a portable crib for its intended purpose.

Based on interviews with L1, S1 and S2, on one occasion a parent arrived at the FCCH facility to pick up their child(ren) and the parent smelled of alcohol. L1, S1 and S2 corroborated that L1 drove the parents children home and the parent drove themselves home.

A1 stated during interview that L1 told them that a parent arrived to pick up their child(ren) and the parent smelled of alcohol, and L1 allowed the parent to drive away with the children and did not report it. It is unclear whether this is the same incident that L1, S1 and S2 were referring to or an additional one.

Based on record review the Department has not been notified of any incident relating to a parent arriving to the facility or driving away from the facility while intoxicated.

Based on interviews conducted and records reviewed, 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 pages. Appeal Rights were provided. A Civil Penalty in the amount of $200 has been accessed on form LIC421BG. Appeal Rights were provided.

Continue on LIC9099-C
SUPERVISORS NAME: Melchisedeck Augustin
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026
LIC9099 (FAS) - (06/04)
Page: 8 of 14
Control Number 01-CC-20251219162844
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: BAUSLEY, JACKIELYN FCCH
FACILITY NUMBER: 493009498
VISIT DATE: 03/12/2026
NARRATIVE
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PAGE 9
Exit interview conducted and report was reviewed with licensee, Jackielyn Bausley.

A notice of site visit was given to licensee and must remain posted for 30 days.

LPA Strother informed licensee Jackielyn Bausely that this report dated 03/12/26 documents 4 Type A citations. Type A citations shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Strother informed the licensee to provide a copy of this licensing report dated 03/12/26 that documents any Type A citation 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.
SUPERVISORS NAME: Melchisedeck Augustin
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026
LIC9099 (FAS) - (06/04)
Page: 9 of 14
Control Number 01-CC-20251219162844
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: BAUSLEY, JACKIELYN FCCH
FACILITY NUMBER: 493009498
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/13/2026
Section Cited
CCR
102370(d)(1)
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(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department
This requirement was not met as evidenced by:
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The plan of correction is that all the employess will have criminal record clearance. All of my employess do have a clearance.
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Based on interview and record review, the licensee did not comply with the section cited above. Adult S3 provided care and supervision to children in the Licensee’s home without a criminal record clearance or exemption on at least two occasions, which poses an immediate health, safety or personal rights risk to persons in care.
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Licensee stated that she will submit a statement of her understanding that all employees, persons living in the home or volunteers must have a clearance associated prior to being in the home.

LPA Strother: amy.strother@dss.ca.gov
Type A
03/13/2026
Section Cited
CCR
102416.5(a)
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(a)The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.



This requirement was not met as evidenced by:
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Licensee stated she will submit a statement of correction. Licensee stated she will speak to her new understanding that the capacity is 14 children to include those in the home and those children she picks up from care to make up the total number of children.
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Based on interview, the licensee did not comply with the section cited above. L1 stated on 12/29/25 that she has had too many children once a month since August 2025 taking some children to stay with her husband at the park. A1 and C2 stated that children were taken upstairs when an inspector came to the home to hide being over capacity, which poses an immediate health, safety or personal rights risk to persons in care.
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LPA Strother: amy.strother@dss.ca.gov
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: Melchisedeck Augustin
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026
LIC9099 (FAS) - (06/04)
Page: 10 of 14
Control Number 01-CC-20251219162844
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: BAUSLEY, JACKIELYN FCCH
FACILITY NUMBER: 493009498
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/13/2026
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...not limited to,...: (4)To be free from corporal or unusual punishment, infliction of pain,... threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning.
This requirement was not met as evidenced by:
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I can not correct something that we didn't do, but I will submit a written statement about my understanding of children's personal rights.

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Based on interview, the licensee did not comply with the section cited above. S1 and S2 have on more than once occasion pulled on children or spanked children with a sandal or their hands, or threatened to call the police on the children which poses an immediate health, safety or personal rights risk to persons in care.

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LPA email: amy.strother@dss.ca.gov
Type A
03/13/2026
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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I will submit a written statement of her understanding of children's personal rights to LPA Strother.
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Based on interview and record review, the licensee did not comply with the section cited above. Assistants S1 & S2 restrained at least one child, A4, age three+ to a portable crib as a form of discipline on more than one occasion, which poses an immediate Health, Safety or Personal Rights risk to children in care.
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Email: amy.strother@dss.ca.gov
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: Melchisedeck Augustin
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026
LIC9099 (FAS) - (06/04)
Page: 11 of 14
Control Number 01-CC-20251219162844
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: BAUSLEY, JACKIELYN FCCH
FACILITY NUMBER: 493009498
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/26/2026
Section Cited
CCR
102417(a)
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(a)The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.
This requirement was not met as evidenced by:
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Licensee will submit her understanding of needing to close when she is away on vacation and will submit a daily schedule to include the times she is away from the home.
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Based on interview, the licensee did not comply with the section cited above when L1 was out of the country 10/09/25 to 10/13/25, when L1 is not present on weekends, and potentially during the week while driving to and from locations throughout the day for up to 4.5 hours, leaving children in care with S2 and/or S1, which poses a potential health, safety or personal rights risk to persons in care.
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LPA Strother's email:
amy.strother@dss.ca.gov
Type B
03/26/2026
Section Cited
CCR
102416.2(b)(3)(C)
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(b)The licensee shall report to the Department any of the events as specified in Health and Safety…1597.467(b)(1)(A) through (b)(1)(C)… (3)… "A report shall be made to the Department…following the occurrence…of any of the following events: (C)Any unusual incident or child absence that threatens the physical or emotional health or safety of any child."
This requirement was not met as evidenced by:
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Licensee stated that she will submit a written statement of her understanding that she should first call law enforcement if the intoxicated person drives away from her facility and would then report any such incident to Licensing by the next business day, submitting a written report LIC624B within 7 days.
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Based on interview and record review, the licensee did not comply with the section cited above. The licensee did not submit a report to the Department when a parent arrived to the facility smelling of alcohol, 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: Melchisedeck Augustin
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026
LIC9099 (FAS) - (06/04)
Page: 12 of 14
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC RO, 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
12/19/2025 and conducted by Evaluator Amy Strother
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20251219162844

FACILITY NAME:BAUSLEY, JACKIELYN FCCHFACILITY NUMBER:
493009498
ADMINISTRATOR:BAUSLEY, JACKIELYNFACILITY TYPE:
810
ADDRESS:2775 CUMBERLAND STREETTELEPHONE:
(707) 888-5130
CITY:SANTA ROSASTATE: CAZIP CODE:
95407
CAPACITY:14CENSUS: 3DATE:
03/12/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jackielyn BausleyTIME COMPLETED:
11:40 AM
ALLEGATION(S):
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Licensee left daycare children unattended.
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 the Licensee left daycare children unattended, specifically that on more than one occasion, the licensee forgot to pick up daycare children from school, leaving the children unattended.

During the initial investigation visit on 12/29/25 at 4:09pm, LPA met with two assistants, S1 and S2 who were observed to be supervising 11 children. Ten minutes into the visit, Licensee (L1) arrived home. LPA requested that L1 review a roster obtained by LPA on 10/30/26 and update it as necessary. L1 added “date left” dates to five children on the roster. LPA conducted interviews with one child (C1) and the Licensee (L1).

During the 12/29/25 interview, L1 admitted that she has forgotten to pick a child or children from the same elementary school that her child attends and that it has happened 2 or 3 times.
Continue on LIC9099-C

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melchisedeck Augustin
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 13 of 14
Control Number 01-CC-20251219162844
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: BAUSLEY, JACKIELYN FCCH
FACILITY NUMBER: 493009498
VISIT DATE: 03/12/2026
NARRATIVE
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PAGE 2
LPA conducted interviews between 02/04/26 and 03/09/26 with 10 adults, Adult 1 – Adult 8 (A1-A8) who were a combination of parents of formerly or currently enrolled children or staff from the elementary school L1 does school pick-ups from, and Staff 1 - Staff 3 (S1-S3) who are assistants at the Family Child Care Home facility. LPA conducted interviews with 2 additional children, Child 2 & Child 3 (C2 & C3) between 03/06/26 and 03/09/26.

On 02/20/26 LPA interviewed two employees from the above-mentioned elementary school, A2 and A3, who confirmed that L1 has forgotten to pick up children 2-3 times and has arrived 10-15 minutes late for pick up, 3 or 4 times since August 2025. Both A2 and A3 made corroborating statements that although L1 was late to pick up children, the children were never left unattended, and were supervised at all times, sitting with A2 in the school office until L1 or another adult picked them up.

Based on interviews conducted, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that an alleged violation occurred, therefore the allegation is UNSUBSTANTIATED.

This report was reviewed and discussed with Licensee, Jackielyn Bausley. Appeal Rights were provided.

A notice of site visit was given to licensee and must remain posted for 30 days.
SUPERVISORS NAME: Melchisedeck Augustin
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026
LIC9099 (FAS) - (06/04)
Page: 14 of 14