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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334840837
Report Date: 10/14/2021
Date Signed: 10/14/2021 11:04:22 AM



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 ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/27/2021 and conducted by Evaluator Taadhimeka Zeigler
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20210827091541
FACILITY NAME:KOLB FAMILY CHILD CAREFACILITY NUMBER:
334840837
ADMINISTRATOR:KOLB, COLLEENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 231-3059
CITY:RIVERSIDESTATE: CAZIP CODE:
92508
CAPACITY:14CENSUS: 5DATE:
10/14/2021
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Colleen KolbTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Licensee yelled at authorized representative while children in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Taadhimeka Zeigler arrived at the facility to complete a complaint investigation into the above allegation. LPA met with Licensee, Colleen Kolb. LPA discussed the purpose of the visit. The facility was toured and the census was taken.

During the investigation, LPA Zeigler reviewed facility documentation and conducted interviews with children, staff, and witnesses who are pertinent to this investigation. It was alleged that Licensee yelled at authorized representative while children were in care.

During interviews with pertinent parties, it was disclosed that Licensee and a parent had a verbal altercation in the presence of children in care. A dispute over the children being picked up late turned into a verbal altercation that was witnessed by children.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Taadhimeka ZeiglerTELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021
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 09-CC-20210827091541
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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: KOLB FAMILY CHILD CARE
FACILITY NUMBER: 334840837
VISIT DATE: 10/14/2021
NARRATIVE
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Based on interviews with pertinent parties, records reviewed, and witness observations, the department has determined the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Citation cited on 9099D.

Exit interview conducted, Appeal Rights, a copy of this report, and notice of site was provided to Licensee.


A copy of this report must be provided to the public upon request.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Taadhimeka ZeiglerTELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 09-CC-20210827091541
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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KOLB FAMILY CHILD CARE
FACILITY NUMBER: 334840837
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/22/2021
Section Cited
CCR
102423(a)
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Personal Rights-Each child receiving services from a family child care home shall be treated with dignity in his/her personal relationship with staff and other persons. This requirement has not been met as evidenced by:
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Licensee agrees to ensure that the personal rights of children in care will not be violated. Licensee will watch videos that are available on the CDSS website regarding the
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Licensee and a parent had a verbal altercation in the presence of children in care. This poses a potential threat to children in care.
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personal rights of children in care. Self declaration will be sent to LPA as proof of correction.
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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: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Taadhimeka ZeiglerTELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3