304270485-7-23-2019-06-CC-RLOZ-BENSJR-20190802135535

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304270485
Report Date: 07/23/2019
Date Signed: 07/23/2019 01:05:05 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/06/2019 and conducted by Evaluator Mahnaz Malek

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20190506170047

FACILITY NAME:	KINDERCARE LEARNING CENTER		FACILITY NUMBER:	304270485
ADMINISTRATOR:	VASSEGHI, MOJGAN		FACILITY TYPE:	830
ADDRESS:	30062 SANTA MARGARITA PARKWAY		TELEPHONE:	(949) 888-8880
CITY:	RANCHO STA MARGARITA	STATE: CA	ZIP CODE:	92688
CAPACITY:	20	CENSUS: 14	DATE:	07/23/2019
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Director		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Infant sustained fracture while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted a follow up investigation to deliver the findings regarding the above complaint allegation which had been started on 5/8/2019. LPA met with director, Mojgan Vasseghi. LPA took census. There were a total of 14 infants and toddlers with 5 staff in two classrooms and on the playground. A review of staff records on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.
Our office has received a compliant report alleging Infant sustained fracture while in care. It was reported a 21 months old was dropped off fine with no injury at the day care in the morning of 5/3/2019. Child's representative picked the child up from daycare, noticing child's arm was winced when staff removed child's arms out of the seat belt of the facility stroller. Child's representative also noticed the child's right arm was “dangling” as they exited the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 703-2810
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2019

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 06-CC-20190506170047

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: KINDERCARE LEARNING CENTER	FACILITY NUMBER: 304270485
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/23/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/26/2019 Section Cited CCR 101212(d)	1 2 3 4 5 6 7	Reporting Requirement- 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	1 2 3 4 5 6 7	The director will send a statement to our office acknowledging the importance of reporting requirements and understanding complying with this section of regulations and reporting unusual incidents to our office in the future in a timely manner.
	8 9 10 11 12 13 14	be submitted to the Department within seven days following the occurrence of such event. This requirement was not met as evidenced by not receiving any reports from the facility when they were notified of an injury which needed medical attention. The facility failed to report this unusual incident to our office. This is a potential risk to the health and safety of 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: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 703-2810
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2019

LIC9099 (FAS) - (06/04)

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Control Number 06-CC-20190506170047

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: KINDERCARE LEARNING CENTER	FACILITY NUMBER: 304270485
	VISIT DATE: 07/23/2019

NARRATIVE

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This complaint allegation has been investigated by investigator, Nikki Vo from Investigation Branch (IB) with our Department. Investigator Vo has interviewed the child's representatives, facility's staff, medical professionals, other law enforcement agencies who were involved in this case, and has obtained child's medical records regarding the above allegation. The medical professionals confirmed child had a small fracture to the elbow. Medical records' x-ray confirmed the fracture is only slightly more than a crack and looks oblique so there was probably some twisting mechanism, but not a high force fracture. It was concluded the injury could have been caused by a fall and it was stated that the injury could be accidental or inflicted. Staff did not acknowledge observing any injury happened to the child. They stated child was fine during the time was attending at day care. Child’s representative brought it up to staff’s attention that the child had swollen arm after leaving the facility. According to staff, child's representative removed child’s seat belt and picked child up out of the stroller. Staff stated they did not observe the child fall or that child was in any pain during the day of incident on 5/3/2019. Staff were not aware that the child’s arm was injured on 5/03/2019.
According to law enforcement agencies interviews which were conducted during the course of the investigation, there was no evidence found to support or corroborate the allegation. It could not be established as to when, where, or how the injury occurred.
This agency has investigated the complaint alleging daycare child sustained injury at day care, 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.
The facility failed to report the unusual incident to our Department within 24 hours. The child's representative informed the facility of the child's injury in the evening of 5/3/2019. This was not reported to our office when the facility learned about the child's injury. This deficiency is cited under Reporting Requirement, section 101212(d) on the next page on LIC 9099D
The Notice of Site Visit was posted. Facility representative was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal Rights was explained. A copy of appeal rights (LIC 9058 1/16) was provided and their signatures on this form acknowledges receipt of these rights. First level appeal is to Regional Manager, address is above on the report. Exit interview was conducted. An updated pamphlet regarding safe sleep regulations in childcare and a pamphlet for lead poisoning facts were given to the director on the last inspection date.

This report ends here..

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 703-2810
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2019

LIC9099 (FAS) - (06/04)

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