364804286-12-14-2022-09-CC-KWIS-CMKTXL-20221229140716

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 364804286
Report Date: 12/14/2022
Date Signed: 12/14/2022 03:53:11 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 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
10/07/2022 and conducted by Evaluator Perla Ordones

COMPLAINT CONTROL NUMBER: 09-CC-20221007123131

FACILITY NAME:	KINDERCARE LEARNING CENTER		FACILITY NUMBER:	364804286
ADMINISTRATOR:	AMANDA CARTER		FACILITY TYPE:	850
ADDRESS:	7221 CHURCH STREET		TELEPHONE:	(909) 862-0967
CITY:	HIGHLAND	STATE: CA	ZIP CODE:	92346
CAPACITY:	70	CENSUS: 26	DATE:	12/14/2022
		UNANNOUNCED	TIME BEGAN:	12:54 PM
MET WITH:	Lisa Stillwell		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Personal Rights - Daycare child sustained a fracture while in care

Reporting Requirements - Facility did not notify child's authorized representative of injury while in care

INVESTIGATION FINDINGS:

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On this date and time, Licensing Program Analysts (LPAs) Perla Ordones and Laura Mejorado arrived at the facility to conclude a complaint investigation which was initiated on 10/13/2022. LPAs met with Facility Representative Lisa Stillwell, toured the facility, took census, and discussed the following.

During the investigation, LPAs made observations, reviewed pertinent documentation and conducted interviews with pertinent parties. During today’s inspection, LPA observed 26 children in care.

It was alleged, that a daycare child sustained a fracture while in care and that the facility did not notify the child’s authorized representative of the injury while in care.

LPAs investigated the allegations and gathered the following information:

Please see LIC9099C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Perla Ordones	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022

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 4

Control Number 09-CC-20221007123131

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KINDERCARE LEARNING CENTER	FACILITY NUMBER: 364804286
	VISIT DATE: 12/14/2022

NARRATIVE

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It was reported, on or about 09/23/2022 that upon pick up a child was witnessed limping to their authorized representative. When the authorized representative questioned staff regarding the child limping, staff reported nothing of note occurred that day. When the authorized representative took the child to a doctor, they found a fracture in the child’s right foot. On 09/26/2022 when the authorized representative informed staff of the child’s fractured foot, it was disclosed that on 09/23/2022 the child was seen climbing a ball cart on the playground and that the cart fell on the child’s foot. When the authorized representative asked for the incident report, the report was dated for 09/26/2022 rather than 09/23/2022.

The following information was collected during the investigation:

Based on interviews with pertinent parties, it was disclosed that an incident did occur on 09/23/2022 while the child was in care. According to interviews, the director and assistant director were present when a ball cart tipped over and fell on a child’s foot. It was disclosed the child was redirected multiple times and instructed not to climb the ball cart. The director stated that nothing was amiss with the child when they were inspected directly after the incident but admitted that the authorized representative was not notified of the occurrence at all upon pick up. Upon inspecting the child’s file and examining the internal incident report, LPAs found that the incident report was dated 09/26/2022 when the incident occurred on 09/23/2022. Moreover, medical documentation was submitted to LPAs during the course of the investigation that supported the fact that the child did sustain an injury on the foot the ball cart fell on while in care.

Based on LPAs observation of medical documentation, interviews and record review, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12 & Chapter 1), are being cited on the attached LIC9099D.

An exit interview was conducted with Facility Representative Lisa Stillwell, Appeal Rights were discussed and issued, a copy of this report was provided, and a Notice of Site visit was issued.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Perla Ordones	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 09-CC-20221007123131

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KINDERCARE LEARNING CENTER	FACILITY NUMBER: 364804286
	VISIT DATE: 12/14/2022

NARRATIVE

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Upon receipt of this report, the Facility Representative shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement of Receipt (LIC 9224 form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224).

A copy of this report must be made available for the next three years

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Perla Ordones	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 09-CC-20221007123131

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KINDERCARE LEARNING CENTER	FACILITY NUMBER: 364804286
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/14/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 12/15/2022 Section Cited CCR 101223(a)(2)	1 2 3 4 5 6 7	The licensee shall ensure that each child is accorded the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Immediately, Director agrees to conduct in-service training on supervision and personal rights and submit the training sign in sheet to CCL by the next business day on 12/15/2022.
	8 9 10 11 12 13 14	Based on interviews and record review, on 09/23/22 a ball cart fell on a child’s foot in the presence of staff and the child sustained a fractured foot, which poses an immediate Health, Safety, or Personal Rights risk to children in care.	8 9 10 11 12 13 14
Type B 01/13/2023 Section Cited CCR 101212(f)	1 2 3 4 5 6 7	The items specified in (d)(1)(A) through (H) above shall also be reported to the child's authorized representative. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Director agrees to conduct in-service training on reporting requirements and submit the training sign in sheet to CCL by the next business day on 12/15/2022.
	8 9 10 11 12 13 14	Based on interviews and record review, on 09/23/22 a ball cart fell on a child’s foot in the presence of staff and the child sustained a fractured foot, authorized representative was not notified until 09/26/22, which poses a potential Health, Safety, or Personal Rights risk to children in care.	8 9 10 11 12 13 14

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 Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Perla Ordones	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022

LIC9099 (FAS) - (06/04)

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