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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 525407977
Report Date: 12/19/2025
Date Signed: 12/19/2025 03:25:48 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/24/2025 and conducted by Evaluator Sydney Sims
PUBLIC
COMPLAINT CONTROL NUMBER: 13-CC-20250924132236
FACILITY NAME:KOTASIK DAYCAREFACILITY NUMBER:
525407977
ADMINISTRATOR:JESSIE RADCLIFF ISLASFACILITY TYPE:
850
ADDRESS:2 SUTTER STREET, SUITE CTELEPHONE:
(530) 727-9607
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY:34CENSUS: 4DATE:
12/19/2025
UNANNOUNCEDTIME BEGAN:
02:48 PM
MET WITH:Jessie RadcliffTIME COMPLETED:
03:35 PM
ALLEGATION(S):
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Facility failed to report unusual incident report as required
INVESTIGATION FINDINGS:
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On 12/19/25 at 2:48pm, Licensing Program Analyst (LPA) Sydney Sims and Erica Laird conducted an unannounced complaint inspection, and met with the Director Jessie Radcliff. It was alleged that Facility failed to report unusual incident report as required specifically that child C1 sustained an injury on 09/23/25 that was not reported to the Community Care Licensing Regional Office as required.

The Director was interviewed on 09/25/25 at 11:41am and admitted that an incident report was not sent to the Community Care Licensing Department (CCLD). Director stated that the reason the incident report was not sent out to CCLD after C1's eye injury was because the Director did not think that the injury warranted an incident report to be filed.

Two of staff (S1 – S2) were interviewed on 09/25/25 and had knowledge of the incident stating that on 09/23/25 child C1 was outside on a bike slamming into another child C2 on a bike and sustained an injury that caused C1’s eye to have blood coming out of it. S1 stated that S1 took the child to the Director and informed the Director that there was blood coming out of the child’s eye.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Sydney Sims
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025
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 5
Control Number 13-CC-20250924132236
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: KOTASIK DAYCARE
FACILITY NUMBER: 525407977
VISIT DATE: 12/19/2025
NARRATIVE
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On 09/25/25 the facility was toured, and the LPA observed the playground where the incident occurred and observed that the bikes being used were age appropriate.

On 09/25/25 facility records were reviewed and there was no documentation on file that showed that the incident on 09/23/25 had been reported to the CCLD as required.

During the investigation LPA conducted interviews with the Licensee, and staff, and reviewed supporting documents that supported the allegations.

Based on the evidence obtained, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, (Title 22), is being cited on the attached LIC 9099D

Exit interview conducted and report was reviewed with the Director Jessie Radcliff. Appeal rights were provided.

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: Megan Aviles
LICENSING EVALUATOR NAME: Sydney Sims
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 13-CC-20250924132236
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: KOTASIK DAYCARE
FACILITY NUMBER: 525407977
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/19/2026
Section Cited
CCR
101212(d)
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Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department... within the Department's next working day and during its normal business hours...
This requirement was not met as evidenced by:
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Director will conduct staff meeting and review the reporting requirments regulations and write statement stating that staff understand and will comply with reporting requirements. Diector will submit POC to LPA Sims to 01/19/2026
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Based on interview, and record review, the licensee did not comply with the section cited above in one count of not reporting a unusual incidnet that occured at the facility on 09/23/25 involving child C1 which poses an potential 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: Megan Aviles
LICENSING EVALUATOR NAME: Sydney Sims
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5