334809081-9-13-2023-10-CC-DMUN-CVNS4B-20230914133226

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 334809081
Report Date: 09/13/2023
Date Signed: 09/13/2023 11:27:50 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SOUTH EAST, 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
07/25/2023 and conducted by Evaluator Alaina Wilburn

PUBLIC

COMPLAINT CONTROL NUMBER: 10-CC-20230725151556

FACILITY NAME:	KINDERCARE LEARNING CENTER		FACILITY NUMBER:	334809081
ADMINISTRATOR:	TARA MARTINEZ		FACILITY TYPE:	850
ADDRESS:	610 E. NUEVO ROAD		TELEPHONE:	(951) 943-6476
CITY:	PERRIS	STATE: CA	ZIP CODE:	92571
CAPACITY:	92	CENSUS: 63	DATE:	09/13/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Tara Martinez		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff did not adequately supervise day care child resulting in day care child getting injured while in care.

INVESTIGATION FINDINGS:

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At 10:30AM on September 13, 2023, Licensing Program Analyst (LPA) Alaina Wilburn conducted an unannounced complaint visit. LPA met with Director Tara Martinez, to deliver the findings on the above stated allegation.

The investigation consisted of interviews with the Director, confidential witnesses, review of a written Declaration from the assigned classroom Teacher and additional supportive evidence.

The investigation revealed the following: On 07/25/2023, a complaint allegation was received by Community Care Licensing (CCL) that staff did not adequately supervise day care child resulting in day care child getting injured while in care. Based on declaration from Staff #1, Child #1 (C1) and another day care child were walking, and Child #2 pushed C1, resulting in C1 tripping and hitting the right side of their eyebrow on the edge/corner of a wood cubbie. While C1 did suffer an injury to the lower right eyebrow that required medical attention, the incident was not a result of negligence or due to a lack of supervision. Staff #1 was present and observed the incident when it occurred, and immediately checked C1 and notified the Director for

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 505-6334
LICENSING EVALUATOR NAME: Alaina Wilburn	TELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

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 10-CC-20230725151556

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: KINDERCARE LEARNING CENTER	FACILITY NUMBER: 334809081
	VISIT DATE: 09/13/2023

NARRATIVE

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Based on interviews conducted and record review, the allegations that staff did not adequately supervise day care child resulting in day care child getting injured while in care, may have happened or is valid, but there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegation is UNSUBSTANTIATED at this time.

Exit interview conducted. A copy of this report and appeal rights were discussed and provided to the Director Tara Martinez on this date.

A NOTICE OF SITE VISIT WAS ISSUED AND LPA VERIFIED THAT IT WAS POSTED IN A PROMINENT LOCATION AT THE FACILITY BEFORE LEAVING. THE LICENSEE UNDERSTANDS THAT IT MUST REMAIN POSTED FOR THE NEXT 30 DAYS.

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 505-6334
LICENSING EVALUATOR NAME: Alaina Wilburn	TELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

LIC9099 (FAS) - (06/04)

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