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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343603018
Report Date: 09/13/2022
Date Signed: 09/13/2022 10:19:50 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/11/2022 and conducted by Evaluator Gagandeep Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20220811084730
FACILITY NAME:KINDERCARE LEARNING CENTER - MACK (INF)FACILITY NUMBER:
343603018
ADMINISTRATOR:PAULA RITTERFACILITY TYPE:
830
ADDRESS:4920 MACK ROADTELEPHONE:
(916) 428-1880
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY:36CENSUS: 17DATE:
09/13/2022
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Paula RitterTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Day child sustained an injury due to lack of supervision.
Staff did not notify authorized representative of incident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Gagandeep Singh met with the director, Paula Ritter, to deliver the findings of the above allegations. Purpose of the inspection was explained.

During the investigation, LPA interviewed the staff, director and reviewed the facility records. During the insvestigation, it was found that there was a child in care, who had injury inside the upper lip. During the interviews and the incident report written by staff member, it was found that no staff observed the injury happening. Per director, the injury was noticed at the time of the pick up. It was found that because no staff observed the injury, the injury was not reported to the parent. Based on the information collected, the allegation was found to be Substantiated. See next page for citation given today. Copy of this report was reviewed and provided to the director. Notice of site visit is posted and shall remain posted for next 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Gagandeep SinghTELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022
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 2
Control Number 03-CC-20220811084730
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: KINDERCARE LEARNING CENTER - MACK (INF)
FACILITY NUMBER: 343603018
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2022
Section Cited
CCR
101429(a)(1)
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Responsibility for Providing Care and Supervision for Infants : Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times. This requirement is not met as evidenced through interviews, it was found staff did not know how did the child get injury.
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Director agreed to conduct the staff training on supervision.
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This poses a potential Health and Safety risk to children in care.
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Type B
09/30/2022
Section Cited
CCR
101226.3(b)
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Any unusual behavior, any injury or signs of illness requiring assessment and/or administration of first aid by staff shall be reported to the child's authorized representative and recorded in the child's record. This requirement is not met as evidenced through interviews it was found that
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Director agreed to conduct the staff training on incident reporting.
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a child had injury inside the upper lip, but the parent was not notified. This poses a potential Health and Safety risk to 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: Natalie DunawayTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Gagandeep SinghTELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2