493010202-9-10-2025-01-CC-MAUN-DLJQ9C-20250915115804

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 493010202
Report Date: 09/10/2025
Date Signed: 09/10/2025 04:47:49 PM

Unsubstantiated

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
06/16/2025 and conducted by Evaluator Yang Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 01-CC-20250616120715

FACILITY NAME:	JONES, KELSIE FCCH		FACILITY NUMBER:	493010202
ADMINISTRATOR:	KELSIE JONES		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 529-6734
CITY:	PETALUMA	STATE: CA	ZIP CODE:	94954
CAPACITY:	14	CENSUS: 4	DATE:	09/10/2025
		UNANNOUNCED	TIME BEGAN:	02:43 PM
MET WITH:	Kelsie Jones		TIME COMPLETED:	04:29 PM

ALLEGATION(S):

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-Staff did not provide child with safe, healthful accommodations, furnishings and equipment resulting in injury

-Staff did not inform authorized representative of incident

INVESTIGATION FINDINGS:

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A follow-up complaint investigation visit was made today by Licensing Program Analyst (LPA), Y. Yang to deliver complaint investigation findings. Previous investigation visits were made to the facility by the LPA on June 25, 2025 and July 23, 2025. It has been alleged that daycare staff failed to provide safe and healthful accommodations, furnishings, and equipment, leading to a child's injury. Specifically, on a certain date, child C1 reportedly sustained unexplained injuries, including a fractured femur and fingers. Additionally, it is claimed that the licensee did not inform the child’s authorized representative of the incident and injuries.

During the June 25 visit and subsequent interview with the licensee, Kelsie Jones, the licensee denied the allegations, stating that she was unaware of any injuries sustained by child C1 while in her care. The licensee explained that she serves as the primary caregiver at the facility and provides direct visual supervision to all children. She also stated that she does not employ any assistants or helpers; however, her spouse may assist on occasion in a limited capacity if needed. According to the licensee, any injuries occurring at the facility are promptly reported to the child's authorized representative, either immediately by phone or at the time of pick-up.
(Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Melchisedeck Augustin
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2025

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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Control Number 01-CC-20250616120715

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: JONES, KELSIE FCCH	FACILITY NUMBER: 493010202
	VISIT DATE: 09/10/2025

NARRATIVE

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The licensee explained that she performs wellness checks during morning drop-off. She stated that C1 attends her facility one day a week. On the day she became aware of C1’s injuries, the licensee stated that C1 seemed fussier than usual, a change she attributed to possible teething discomfort or hunger. Although C1 normally has a hearty appetite, that day C1 ate less than usual. The licensee reported observing nothing unusual during diaper changes. Per the licensee, C1 napped several times in both the morning and afternoon and engaged in play and interaction with other children throughout the day. Despite still eating little as the day progressed, the licensee stated she believed C1 was teething and offered several frozen teething toys, which C1 used and appeared to enjoy.

The licensee explained that in the afternoon, a relative picked up C1. The licensee stated she informed the relative about how C1’s day had gone, mentioning that C1 seemed fussier than usual and may have been experiencing teething discomfort. To support C1 further, she offered the relative a frozen teething toy to help soothe the discomfort. The licensee was unequivocal in stating that no injuries or accidents occurred while C1 was in her care and that nothing observed that day warranted notifying the authorized representative or seeking medical attention. The licensee stated that the only time C1 was out of her direct line of sight was during nap time. The licensee stated that she physically checked on C1 every 15 minutes.

Around midnight on the same day, the licensee stated that she received a message from C1’s authorized representative indicating that C1 was in the emergency room with a fractured femur. The licensee stated this was completely unexpected, as she had not observed any injuries when C1 was picked up earlier that day by a relative. Additionally, the licensee noted that she had not been informed about C1’s fractured fingers; she only learned of those injuries during a follow-up visit by the LPA on July 23, 2025. The licensee reaffirmed that, had she noticed any signs of injury or trauma, she would have immediately notified C1’s authorized representative.

The licensee confirmed that on the day in question, she used a Skip Hop activity center, a Graco swing, and a BabyBjörn bouncer with C1, with each used multiple times in strict accordance with the manufacturers’ instructions and with supervision. The licensee emphasized that none of these devices were used for napping; any child who falls asleep is promptly placed in a crib. During the initial investigation visit, the LPA verified that all devices were age-appropriate and currently free from any recalls. Additionally, the LPA toured the facility and observed that childcare areas were suitable for infants, with toys and equipment in good repair and sufficient protective padding on the floor.

(Continued on LIC9099-C)

SUPERVISORS NAME: Melchisedeck Augustin
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2025

LIC9099 (FAS) - (06/04)

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Control Number 01-CC-20250616120715

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: JONES, KELSIE FCCH	FACILITY NUMBER: 493010202
	VISIT DATE: 09/10/2025

NARRATIVE

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As part of the investigation, interviews were conducted with the facility’s clients, children, and other individuals with knowledge of the facility, but no corroborating information was obtained from these interviews. Additionally, records from the local law enforcement agency did not provide any evidence supporting the allegation of staff misconduct related to the incident under investigation. During the initial visit to the facility on June 25, the follow-up inspection visit on July 23, and on today’s visit, the LPA found no evidence of personal rights violations at the facility or unsafe environments for daycare children. The incident was reported to Community Care Licensing verbally and by a written report as required by regulations.

Based on available information, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove alleged violations did or did not occur, therefore, the allegations are determined to be unsubstantiated at this time. There were no Title 22 deficiencies cited. This report was reviewed and discussed with the facility’s Licensee, Kelsie Jones. Appeal rights were provided. Notice of Site Visit shall be posted for 30 days from today's visit.

SUPERVISORS NAME: Melchisedeck Augustin
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2025

LIC9099 (FAS) - (06/04)

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