304270485-9-30-2020-06-CC-RLOZ-BTXUVT-20200930155537

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304270485
Report Date: 09/30/2020
Date Signed: 09/30/2020 01:49:04 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
02/18/2020 and conducted by Evaluator Mahnaz Malek

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20200218135636

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: 17	DATE:	09/30/2020
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Director		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Day care child sustained unexplained burn while in care

INVESTIGATION FINDINGS:

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Tele-Investigation due to Covid-19 State of Emergency- page 1 of 3

On 9/30/2020 Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted a Tele- investigation at 12:15 pm via FaceTime to deliver the finding for the complaint allegation of a day care child sustained unexplained burn while in care. This complaint investigation was initiated on 2/19/2020. LPA met with director, Mojgan Vasseghi remotely via FaceTime application. LPA notified the director that due to Covid-19 and Department of Public Health (DPH) guidelines of social distancing a tele investigation is conducted. The Covid-19 Emergency Response questionnaires were asked. There were a total of 17 infants and toddlers with 4 staff at the facility. There were 5 awake infants with 2 staff in the infant room, 4 napping toddlers with one staff in Toddler room 1, and 8 napping toddlers with one staff in Toddler room 2 observed via FaceTime.
A review of the Facility Personnel Report Summary on 9/30/2020 indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
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Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2020

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 4

Control Number 06-CC-20200218135636

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: 09/30/2020

NARRATIVE

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On 02/18/20, the Orange County Child Care Office received a complaint alleging an 11 months old infant sustained a second degree burn on the back of the child's right leg on 11/8/2019. The infant was picked up from the facility in the late afternoon that day.

Law enforcement, and Child Protective Services (CPS) were involved in this investigation as well.
This complaint allegation was assigned to investigator, Jesse Vargas from the Investigation Branch (IB) with our Department. Based on the Investigator Vargas’ reports, four staff were interviewed at the facility, sign in/out sheet and incident report were reviewed. Child's representatives, one adult, and one minor qualified child were interviewed. Medical reports and Law enforcement reports were obtained and reviewed. According to Investigator Vargas' report, the burn on the child was discovered, and documented during a diaper change around 10:50 to 11:00 a.m. on 11/8/2019. Child arrived at the daycare on that day at 7:40 a.m. Child was picked up in the evening. Child's representative was not notified of the discovery of the burn timely during the changing of the diaper. No incident report was given to the child's representative at the time child was picked up. The facility failed to notify the authorized representative immediately of child’s injury which violates the Health-Related Services regulation and is being cited on the LIC 9099D of this report.

It was discovered during the investigation that the child was under the care of another adult for few hours after child was picked up from the facility until the burn was discovered. That adult notified the parent. Child was taken to the Emergency Room. Per Pediatrician, child was diagnosed with second degree burn which was very unlikely to be intentional and the burn did not look like an immersion burn.
Child Abuse Pediatrician estimates the burn to be anywhere from a few hours to a day old by the time it was photographed. Based on the medical report, which was obtained, the nature and pattern of child's partial thickness burn are most consistent with contact with a heated solid object. There is not enough pattern to easily identify the object. Staff at the facility denied any incidents or injuries occurring at the facility.
According to law enforcement and Child Protective Services reports, interviews were conducted during the investigation, a review of the facility and child's home physical plant, was conducted and there was no evidence or explanation on how the injury occurred. All the interviewees deny the burn incident occurred under their care.

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SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2020

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 06-CC-20200218135636

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: 09/30/2020

NARRATIVE

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This agency has investigated the complaint alleging a daycare child sustained an unexplained second degree burn while in 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.

During the course of the investigation, it was discovered the facility failed to immediately notify the child’s authorized representative that they had observed an injury which required medical attention. Health-Related Services Section 101226(a) is being cited which states: The licensee shall immediately notify the child's authorized representative if the child becomes ill or sustains an injury more serious than a minor cut or scratch. The licensee shall obtain specific instructions from the authorized representative regarding action to be taken.

The Notice of Site Visit was not posted due to tele-investigation Covide-19 State of Emergency. Appeal Rights was explained. A copy of appeal rights (LIC 9058 1/16) will be provided through email and their signatures on this form acknowledges receipt of these rights. (The "Read Receipt" is in lieu of a signature). First level appeal is to Regional Manager, address is above on the report. Exit interview was conducted.

This report ends here.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2020

LIC9099 (FAS) - (06/04)

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Control Number 06-CC-20200218135636

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: 09/30/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/02/2020 Section Cited CCR 101226(a)	1 2 3 4 5 6 7	101226(a) The licensee shall immediately notify the child's authorized representative if the child becomes ill or sustains an injury more serious than a minor cut or scratch. The licensee shall obtain specific instructions from the authorized representative regarding action to be taken. This requirement was not met as evidenced by child’s representatives not	1 2 3 4 5 6 7	The facility representative agreed to send a statement acknowledging the importance of this section of regulations regarding Health-Related Services. The statement will be due in our office on or before 10/2/2020. The acknowledgement statement may be emailed to LPA's email which was provided.
	8 9 10 11 12 13 14	being notified of their 11 month old child’s injury discovered by staff which needed medical attention during diaper changing on 11/8/2019. No incident report was provided to the child’s representative at child’s pick-up time either. The facility failed to comply with this requirement. This is a potential risk to the health and safety of children in care.	8 9 10 11 12 13 14
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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: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2020

LIC9099 (FAS) - (06/04)

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