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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013412610
Report Date: 07/09/2024
Date Signed: 07/09/2024 01:47:38 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/24/2024 and conducted by Evaluator Morgan Pringle
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20240424131702
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
013412610
ADMINISTRATOR:JAMIE CZELUSNIAKFACILITY TYPE:
830
ADDRESS:4655 LASSEN ROADTELEPHONE:
(925) 455-1560
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY:36CENSUS: 24DATE:
07/09/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH: Jaime CzelusniakTIME COMPLETED:
01:46 PM
ALLEGATION(S):
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Personal Rights
INVESTIGATION FINDINGS:
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On 7/9/2024 at 10:00am Licensing Program Analyst (LPA) Morgan Pringle met with Director Jaime Czelusniak for a complaint that was filed against the facility regarding the allegation listed above. Facility is dual licensed and holds a license for preschool (013412608) as well. Present during the visit was twenty-four (24) infants and seven (7) additional staff members.

Through LPA's investigation, interviews were conducted and documents were collected.
LPA determined although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore, the allegation is UNSUBSTANTIATED.

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.

Exit interview conducted and report was reviewed with Director Jamie Czelusniak.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/24/2024 and conducted by Evaluator Morgan Pringle
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20240424131702

FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
013412610
ADMINISTRATOR:JAMIE CZELUSNIAKFACILITY TYPE:
830
ADDRESS:4655 LASSEN ROADTELEPHONE:
(925) 455-1560
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY:36CENSUS: 24DATE:
07/09/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH: Jaime CzelusniakTIME COMPLETED:
01:46 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff served expired formula to infant.
INVESTIGATION FINDINGS:
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5
6
7
8
9
10
11
12
13
On 7/9/2024 at 10:00am Licensing Program Analyst (LPA) Morgan Pringle met with Director Jaime Czelusniak for a complaint that was filed against the facility regarding the allegation listed above. Facility is dual licensed and holds a license for preschool (013412608) as well. Present during the visit was twenty-four (24) infants and seven (7) additional staff members.

Through LPA's investigation, interviews were conducted and documents were collected. Through LPA's investigation it was found that one (1) infant in care was accidently given formula that was provided by the facility, that was later found to be expired. The child did not sustain any side affects from the expired formula and proper formula was provided to the child.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 52-CC-20240424131702
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 013412610
VISIT DATE: 07/09/2024
NARRATIVE
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LPA determined 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. Failure to submit Proof of Corrections (POC) by Plan of Correction date may result in civil penalties.

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.

Exit interview conducted and report was reviewed with Director Jamie Czelusniak.
SUPERVISOR'S NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 52-CC-20240424131702
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 013412610
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/12/2024
Section Cited
CCR
101427(c)(2)
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101427(c) The infant shall be fed in accordance with the individual plan. (2) The infant care center shall have appropriate food available for the infant. This requirement was not met as evidenced by:
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Director will submit a statement explaining the procedures on ensuring that all food/formula supplied to the children in care is in good serving condition and not expired. Director will submit statement to LPA Pringle by the POC date listed.
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One (1) infant in care was accidently given expired formula while in care. This poses a potential risk to the health, safety and personal rights of the 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.
SUPERVISOR'S NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5