093623367-4-15-2022-03-CC-SDLA-CE5S58-20220505133354

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 093623367
Report Date: 04/15/2022
Date Signed: 04/15/2022 01:26:34 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/25/2022 and conducted by Evaluator Christopher Bello

PUBLIC

COMPLAINT CONTROL NUMBER: 03-CC-20220325124105

FACILITY NAME:	BUILDING KIDZ EL DORADO HILLS		FACILITY NUMBER:	093623367
ADMINISTRATOR:	KUNIS, SHELBY		FACILITY TYPE:	850
ADDRESS:	5041 ROBERT J MATTHEWS PRKY200		TELEPHONE:	(916) 358-5276
CITY:	EL DORADO HILLS	STATE: CA	ZIP CODE:	95762
CAPACITY:	48	CENSUS: 13	DATE:	04/15/2022
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Cindi Buccalo		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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7
8
9

Child found alone in office without supervison

INVESTIGATION FINDINGS:

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13

Licensing Program Analyst (LPA) Christopher Bello arrived at the facility at approximately 9:45am and met with director Shelby Kunis to continue and close a complaint investigation, regarding the above allegation. Upon arrival, LPAs observed 13 Children with four teachers. Approximately an hour later owner/administrator Cindi Buccalo arrived. It was alleged that child#1 left a class unattended and went into the facility office that had a door that leads to the facility parking lot unsupervised. LPA made observations, gathered documents pertaining to the investigation and conducted interviews. Three out of the four staff present that day corroborated the allegation admitting that the incident did occur and that they did not know that the child went missing from the class. Documents gathered corroborated the allegation. Cindi stated that the incident was unacceptable, and that it was the volunteer teacher who is no longer allowed to work in the facility. Based on LPA's investigation, the preponderance of evidence standard has been met, therefore, the above allegations are found to be Substantiated. Civil penalty in the amount of $500.00 is assessed for absence of supervision. LPA cleared the deficiency. Title 22 deficiencies are cited on the subsequent page of this report. Type Acknowledgement forms are to be signed by current parent of the facility and new parents for the next twelve months. LIC 9224 and Appeal Rights were provided. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Owner.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher Bello	TELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2022

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 3

Control Number 03-CC-20220325124105

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: BUILDING KIDZ EL DORADO HILLS	FACILITY NUMBER: 093623367
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/15/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/16/2022 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement has not been met as evidence: Child#1 escaped from their classroom and went to	1 2 3 4 5 6 7	The teacher in charge of the class the child escaped from no longer works at the facility. Civil penalty in the amount of $500.00 is assessed for absence of supervision. LPA cleared the deficiency.
	8 9 10 11 12 13 14	the facility office. The facility office leads to the parking lot. This is considered as an immediate risk to the children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher Bello	TELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/25/2022 and conducted by Evaluator Christopher Bello

PUBLIC

COMPLAINT CONTROL NUMBER: 03-CC-20220325124105

FACILITY NAME:	BUILDING KIDZ EL DORADO HILLS		FACILITY NUMBER:	093623367
ADMINISTRATOR:	KUNIS, SHELBY		FACILITY TYPE:	850
ADDRESS:	5041 ROBERT J MATTHEWS PRKY200		TELEPHONE:	(916) 358-5276
CITY:	EL DORADO HILLS	STATE: CA	ZIP CODE:	95762
CAPACITY:	48	CENSUS: 13	DATE:	04/15/2022
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Cindi Buccalo		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Volunteer left alone with day care children
Staff handled day care child in a rough manner

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Christopher Bello arrived at the facility at approximately 9:45am and met with director Shelby Kunis to continue and close a complaint investigation, regarding the “Volunteer left alone with day care children” and “Staff handled day care child in a rough manner” allegations. Upon arrival, LPAs observed 13 Children with four teachers. Approximately an hour later owner/administrator Cindi Buccalo arrived. Regarding the “Volunteer left alone with day care children” allegation, It was alleged that a volunteer was allowed to be alone with the daycare children without a teacher’s supervision. Staff interviews did not corroborate the allegation. Regarding the “Staff handled day care child in a rough manner” allegation, it was alleged that staff#1 held down a daycare child#2. Five out of five staff interviews did not corroborate the allegation. Six out of the six children interviews did not corroborate the allegation. Five out of the five parent interviews did not corroborate allegation. Based on LPA’s investigation, the preponderance of evidence standard has not been met, therefore, the above allegations are found to be unsubstantiated. 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.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher Bello	TELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 3