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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343603026
Report Date: 12/23/2020
Date Signed: 12/23/2020 01:59:42 PM



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
09/16/2020 and conducted by Evaluator Karyn Guerra
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20200916134538
FACILITY NAME:KINDERCARE LEARNING CENTER - SAN JUAN (SA)FACILITY NUMBER:
343603026
ADMINISTRATOR:ALLRED, DAWNAFACILITY TYPE:
840
ADDRESS:5448 SAN JUAN AVENUETELEPHONE:
(916) 961-5599
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:28CENSUS: 21DATE:
12/23/2020
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Dawna AllredTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff inappropriately handled a child in care

Facility staff did not report incident to the authorized representative
INVESTIGATION FINDINGS:
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At 10:00 a.m. on Wednesday, December 23rd, 2020, Licensing Prgram Analyst (LPA) Karyn Guerra met with Director, Dawna Allred, to deliver findings for a complaint investigation. A tele-inspection was conducted due to COVID-19. Census consisted of 21 School Aged children supervised by 2 staff.

It was alleged that staff inappropriately handled a child in care. There was a second allegation that facility staff did not report the incident to the authorized representative. Investigator Shannon Borton from the Department's Investigations Branch conducted the investigation. Based upon evidence obtained, there is a preponderance of evidence to support the above allegations; therefore, the findings are SUBSTANTIATED.

Report continued on 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 216-7796
LICENSING EVALUATOR NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2020
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 03-CC-20200916134538
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 - SAN JUAN (SA)
FACILITY NUMBER: 343603026
VISIT DATE: 12/23/2020
NARRATIVE
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Title 22 deficiencies are cited on the subsequent pages of this report. Director acknowledges, that for TYPE A DEFICIENCIES ONLY upon receipt, Director shall post LIC 9099-D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the Director. This report was reviewed with the Director. Report, appeal rights, LIC 9224, and notice of site visit will be delivered electronically to Director via email. Acknowledgement of receipt of reports will be documented in lieu of signature.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 216-7796
LICENSING EVALUATOR NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 03-CC-20200916134538
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 - SAN JUAN (SA)
FACILITY NUMBER: 343603026
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/23/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/24/2020
Section Cited
CCR
101223(a)(3)
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101223 Personal Rights. (a) The licensee shall ensure that each child is accorded the following personal rights: (3) To be free from corporal or unusual punishment, infliction of pain...other actions of a punitive nature including but not limited to: interference with functions of daily living...This requirement was not met, as evidenced by:
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Director stated that staff in question has been terminated. Director stated that an all staff training was conducted on 10/12/2020 during a professional development day. Director will follow up with documentation to LPA by POC due date.
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Based on evidence, it was determined that child 1 (C1) was handled inappropriately by being grabbed by the arm by Staff 1 (S1). This poses an immediate 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: Keven PetersTELEPHONE: (916) 216-7796
LICENSING EVALUATOR NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 03-CC-20200916134538
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 - SAN JUAN (SA)
FACILITY NUMBER: 343603026
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/23/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/22/2021
Section Cited
CCR
101212(f)
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101212 Reporting Requirements (f) The items specified in (d)(1)(A) through (H) above shall also be reported to the child's authorized representative. This requirement was not met, as evidenced by:
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Director stated that District Leader reviewed directives and processes with Acting Director at the time. Director will follow up with documentation to LPA by POC due date.
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Based on evidence, it was determined that the child's authorized representative was not notified of an unusual incident that occurred. This poses a potential 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: Keven PetersTELEPHONE: (916) 216-7796
LICENSING EVALUATOR NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2020
LIC9099 (FAS) - (06/04)
Page: 4 of 4