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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 100400329
Report Date: 11/08/2019
Date Signed: 11/08/2019 04:26:46 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/07/2019 and conducted by Evaluator Angelica Slaughter
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20191107120940
FACILITY NAME:KIDS KARE OLIVE AVEFACILITY NUMBER:
100400329
ADMINISTRATOR:KRAMPE, KRISTINFACILITY TYPE:
850
ADDRESS:2765 E OLIVE AVETELEPHONE:
(559) 485-6271
CITY:FRESNOSTATE: CAZIP CODE:
93701
CAPACITY:50CENSUS: 30DATE:
11/08/2019
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Kristin KrumpeTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Facility failed to report incident involving child's possible consumption of rocks at facility.
INVESTIGATION FINDINGS:
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On this date, Licensing Program Analyst (LPA) Angelica Slaughter and Licensing Program Manager (LPM) Diana de Leon conducted a complaint inspection to the facility and met with Kristin Krampe. The purpose of the inspection is to cite for the above complaint allegation.

Based on the information obtained during this inspection, there is a preponderance of the evidence to prove the facility failed to report an incident involving child's possible consumption of rocks at facility; therefore, the allegation is substantiated.

Per California Code of Regulation, Title 22, Division 12, a deficiency is being cited (continued on next page).

Licensee was provided a copy of the report, appeal rights, and a LIC 9213 - NOTICE OF SITE VISIT form, which is required to be posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Angelica SlaughterTELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2019
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 2
Control Number 04-CC-20191107120940
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: KIDS KARE OLIVE AVE
FACILITY NUMBER: 100400329
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/12/2019
Section Cited
CCR
101212(d)(1)(B)
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Reporting Requirements - 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 by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.
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Director indicated the responsibilty of reporting this type of incident falls on Human Resources. She stated she reported the incident to Jeanne at the main office. Director Kristin Krampe contacted Human Resources for POC. Spoke with Deanna Jack.
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Events reported shall include the following: Any injury to any child that requires medical treatment. This requirement was not met as evidenced by: Non-reporting of an incident involving a child possibly ingesting rocks/gravel at the facility. This posses a potential risk to the health, safety and/or personal rights of children in care.
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She will communicate will the Owner of the facility and will submit a detailed POC by 4 pm on 11/12/19.
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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: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Angelica SlaughterTELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 2