376700314-11-8-2023-51-CC-TDAL-CXNR6Q-20231117114504

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 376700314
Report Date: 11/08/2023
Date Signed: 11/08/2023 04:59:33 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 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
10/24/2023 and conducted by Evaluator Selina Siao

PUBLIC

COMPLAINT CONTROL NUMBER: 51-CC-20231024084102

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: 12	DATE:	11/08/2023
		UNANNOUNCED	TIME BEGAN:	03:50 PM
MET WITH:	Katherine Benn aka Barnes/Assistant Director		TIME COMPLETED:	05:10 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

A staff is forcefully feeding infants in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 11/08/2023 at 3:50pm, Licensing Program Analysts (LPAs) Selina Siao and Martha Avila conducted an unannounced inspection to deliver finding on the above reference allegation. The initial inspection was conducted by LPA Siao on 10/27/2023. LPAs met with Assistant Director Katherine Benns and conducted a tour of the infant room. Appropriate ratio was observed.
Throughout the course of investigation, interviews were conducted with several staff members, the alleged staff (S1) and a day care parent. Based on information gathered, S1 has been removing the infant bottle screw ring with the nipple off the bottle and poured the milk directly into a six-month-old infant's mouth on several occasions. The most recent incident was on October 18, 2023, and the infant was crying while being feed. The incidents was observed by other staff members and the alleged staff (S1) admitted that she had removed the top of the bottle to feed the infant due to the infant having a hard time latching while the child was whining. Based on preponderance of evidence, the above allegation regarding a staff member forcefully feeding infants in care is substantiated.
LPAs informed facility representative Assistant Director that this report dated 11/08/2023 documents one Type A citation. Type A citation shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Selina Siao	TELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

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 51-CC-20231024084102

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 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: 11/08/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/17/2023 Section Cited CCR 101223(a)(3)	1 2 3 4 5 6 7	Personal Rights: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating etc...	1 2 3 4 5 6 7	Facility representative stated that the facility has updated an infant serving guideline policy. A copy of the policy was provided to LPA today. Monthly team meeting will be held with the infant staff to address any concerns or have open
	8 9 10 11 12 13 14	The requirement is not met as evidence by: A staff member (S1) has been removing the infant bottle screw ring with the nipple off and poured the milk directly into a six-month-old infant's mouth on several occasions while the infant was crying or whining. This poses an immediate health and safety risk to clients in care.	8 9 10 11 12 13 14	discussion with staff members. Facility representative will go over the personal rights licensing regulation and the risk of infants choking on milk with all infant staff members. A copy of the agenda and staff members sign in sheet shall be submitted to licensing no later than 11/17/2023.
	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: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Selina Siao	TELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 51-CC-20231024084102

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: KIDS' CARE CLUB - INFANT	FACILITY NUMBER: 376700314
	VISIT DATE: 11/08/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Also, LPAs informed the facility representative to provide a copy of this licensing report dated 11/08/2023 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

See LIC9099D for type A citation issued:

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Selina Siao	TELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3