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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 393603299
Report Date: 10/19/2022
Date Signed: 10/19/2022 01:52:40 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
09/07/2022 and conducted by Evaluator Stacey Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20220907140355
FACILITY NAME:KINDERCARE LEARNING CENTER - GRANTLINE (PRESCHOOL)FACILITY NUMBER:
393603299
ADMINISTRATOR:EVA PRADOFACILITY TYPE:
850
ADDRESS:265 W. GRANTLINE ROADTELEPHONE:
(209) 835-9247
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY:120CENSUS: 56DATE:
10/19/2022
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Eva Prado TIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff did not meet daycare child’s dietary needs resulting in allergic reaction
INVESTIGATION FINDINGS:
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On October 19, 2022 , Licensing Program Analyst (LPA) Stacey Williams arrived at the facilty for the purpose of delivering complaint findings. LPA met with Facility Representative. LPA observed four classrooms( 56) fifty six children ( napping ) supervised by five staff.

An investigation was conducted regarding the allegation listed above. The facility was toured and interviews were conducted with the reporting party, facilty staff, and parents. Additional pertinent information was received to assist with the investigation. The investiagtion revealed that Child #1(C1) ingested food while at the facility that caused an allergic reaction. The facilty was aware of C1's documented allergies. Staff reported C1 was not seen eating the food item. Staff confirmed that C1 was placed at a different table than where they had previously sat for meals. This table occupied a larger amount of children. Evidence presented during the investigation revealed that C1's parents were notified and medical attention was provided once it was revealed that C1 was experiencing sytmptoms of a potential allergic reaction.

A perponderance of evidence has been met to substantiate the allegation.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022
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 3
Control Number 53-CC-20220907140355
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 - GRANTLINE (PRESCHOOL)
FACILITY NUMBER: 393603299
VISIT DATE: 10/19/2022
NARRATIVE
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Title 22 deficiencies will be cited on subsequent page, LIC 809D.

Exit interview conducted at which time the report was reviewed with Facility Representative, Eva Prado. A Notice of Site Visit was posted by LPA Williams and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 53-CC-20220907140355
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 - GRANTLINE (PRESCHOOL)
FACILITY NUMBER: 393603299
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/18/2022
Section Cited
CCR
101229(a)
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The licensee shall provide care and supervision as necessary to meet the children's needs.
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Facitly Director train all staff on supervision and making sure that the children's dietary needs are met.Training will include the allergy list and protocols. Training roster, agenda, and training documents will be submitted to CCL by POC date- 11/18/22
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This requirment was not met as evidenced by:
C1 ingested food that was a documented allergy while at the facility. This poses a potential risk to the health and safety of 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: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3