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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334804324
Report Date: 09/20/2021
Date Signed: 09/20/2021 12:46:41 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/14/2021 and conducted by Evaluator Lakesha Edwards
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20210714112541
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
334804324
ADMINISTRATOR:MARGARITA D. GUILLERMOFACILITY TYPE:
840
ADDRESS:23301 OLIVEWOOD PLAZA DRIVETELEPHONE:
(951) 924-1956
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY:48CENSUS: 0DATE:
09/20/2021
UNANNOUNCEDTIME BEGAN:
11:37 AM
MET WITH:Margarita D. Guillermo-DirectorTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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Staff pushed daycare child
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) LaKesha Edwards conducted a virtual visit with the facility to conclude an investigation into the above allegation. LPA toured the facility virtually and verified census.

During this investigation, interviews were conducted with the Director, staff, and children. LPA obtained and reviewed pertinent documentation. The allegation alleges staff pushed daycare child. Based on interviews with the Director, it is alleged that child 1 (C1) was bothering other daycare children, and was told by the alleged staff member to leave the other children alone and pushed the child on the forehead to where the child lost their balance and almost fell off of their chair. Child 2 (C2) observed the incident as described. LPA interviewed 3 other staff and no other staff member had witnessed the incident occur.

(Continued on 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Lakesha EdwardsTELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021
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 10-CC-20210714112541
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 334804324
VISIT DATE: 09/20/2021
NARRATIVE
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Based on the information gathered during the investigation and the allegation that staff pushed a daycare child, the preponderance of evidence standard has been met; therefore, the above allegation was found to be SUBSTANTIATED.

See LIC9099D for cited deficiency. Appeal rights discussed and a copy of this report was provided via email to the director on this date.



A NOTICE OF SITE VISIT WAS ISSUED VIA EMAIL AND LPA WILL RECEIVE A PHOTO TO VERIFY THAT IT WAS POSTED IN A PROMINENT LOCATION AT THE FACILITY. THE LICENSEE UNDERSTANDS THAT IT MUST REMAIN POSTED FOR THE NEXT 30 DAYS
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Lakesha EdwardsTELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 10-CC-20210714112541
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 334804324
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/20/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/27/2021
Section Cited
CCR
101223(a)(1)
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101223 (a)(1) Personal Rights: (a) Personal Rights (a)The licensee shall ensure that each child is accorded the following personal rights: (1) To be accorded dignity in his/her personal relationships with staff and other persons.

This requirement was not met as evidenced by:
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The Director has agreed to conduct personal rights training with the staff and submit the sign-in sheet along with training materials to CCL by the due date of 9/27/2021.
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Based on interviews conducted, a child in care was bothering other children and it was alleged the staff member told the child to leave the other children alone and pushed the forehead of the child almost causing the child to fall off of the chair. Another child also witnessed the incident. This poses a potential risk to the Health & Safety of 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: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Lakesha EdwardsTELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3