376700314-5-10-2019-20-CC-JGAY-BDCUQ6-20190621154635

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 376700314
Report Date: 05/10/2019
Date Signed: 05/10/2019 09:33:07 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/22/2019 and conducted by Evaluator Michelle Hood

PUBLIC

COMPLAINT CONTROL NUMBER: 20-CC-20190322091708

FACILITY NAME:	KIDS' CARE CLUB-INFANT		FACILITY NUMBER:	376700314
ADMINISTRATOR:	TOBI STEINER		FACILITY TYPE:	830
ADDRESS:	10414 CRAFTSMAN WAY		TELEPHONE:	(858) 675-7000
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92127
CAPACITY:	20	CENSUS: 11	DATE:	05/10/2019
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Tobi Steiner, Director		TIME COMPLETED:	09:45 AM

ALLEGATION(S):

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Child received unexplained injury while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michelle Hood arrived to conduct an unannounced inspection to deliver complaint findings for the above listed allegation. LPA met with Director. It was alleged child received unexplained injury while in care. Based on Director, staff, and parent interviews, it was determined that on 03/20/19, Child #1 (C1) was assessed after parent observed multiple minor injuries to C1’s face. According to facility staff, C1 did not show signs of injury, nor exhibit any other signs of distress. Staff were unaware of how or when the injuries occurred, but suspected the injuries may be self-inflicted. On 03/21/19, C1’s parent informed facility staff that a subsequent medical assessment was performed by a pediatrician and child abuse specialist. Based on evidence obtained, LPA is unable to determine where the injuries occurred or whether a lack of supervision contributed to the injury.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (559) 243-4588
LICENSING EVALUATOR NAME: Michelle Hood	TELEPHONE: (619) 767-2241
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2019

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 20-CC-20190322091708

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: KIDS' CARE CLUB-INFANT	FACILITY NUMBER: 376700314
	VISIT DATE: 05/10/2019

NARRATIVE

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Due to conflicting statements obtained during the course of the investigation, the above allegation is found to be UNSUBSTANTIATED meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Director was provided appeal rights (LIC9058 01/16) and their signature on this form acknowledges receipt of these rights. Provided Notice of Site Visit. LPA observed that LIC 9213 was posted. An exit interview was conducted.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (559) 243-4588
LICENSING EVALUATOR NAME: Michelle Hood	TELEPHONE: (619) 767-2241
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2019

LIC9099 (FAS) - (06/04)

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Control Number 20-CC-20190322091708

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: KIDS' CARE CLUB-INFANT	FACILITY NUMBER: 376700314
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/10/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B CCR	1 2 3 4 5 6 7	See LIC 809 dated 06/19/2019. Created in error. DO NOT RECORD.	1 2 3 4 5 6 7
	8 9 10 11 12 13 14		8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Jason Garay	TELEPHONE: (559) 243-4588
LICENSING EVALUATOR NAME: Michelle Hood	TELEPHONE: (619) 767-2241
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2019

LIC9099 (FAS) - (06/04)

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