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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 483001838
Report Date: 07/29/2022
Date Signed: 07/29/2022 01:49:14 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/21/2022 and conducted by Evaluator Melchisedeck Augustin
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20220421080220
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
483001838
ADMINISTRATOR:FIELDS, DONJEFACILITY TYPE:
850
ADDRESS:35 ROTARY WAYTELEPHONE:
(707) 557-3007
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:72; 72CENSUS: 46DATE:
07/29/2022
UNANNOUNCEDTIME BEGAN:
08:32 AM
MET WITH:Donje Fields - Center DirectorTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Staff allowed daycare children to engage in inappropriate interactions
Facility staff did not notify child's authorized representative of an incident report
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), M. Augustin conducted an unannounced subsequent complaint-Investigation visit and met with Center Director, Donje Fields (CD) to deliver the findings regarding the above allegations. LPA E. Hernandez-Torres previously met with CD on 04/28/22 to initiate the investigation by discussing the purpose of the visit, conducting interviews with children and CD, and requesting Unusual Incident Reports (UIR), incident reports, and facility roster of the children currently in care. It was alleged that staff allowed daycare children to engage in inappropriate interactions and facility staff did not notify a child’s authorized representative of an incident report. The report more specifically noted an incident involving one child putting bark in another child’s pants while on the playground and another incident where another child was choked in the classroom.

On 04/28/22, LPA, Hernandez-Torres interviewed CD and two children (C1 & C3). LPA, Augustin interviewed four staff (S1-S3 & AD) and three parents (P1-P3); and reviewed Incident/Accident reports from 04/28/22 through 07/14/22. (Continue to LIC 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022
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 5
Control Number 01-CC-20220421080220
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 483001838
VISIT DATE: 07/29/2022
NARRATIVE
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Some children were not verbal, too young to interview, or did not qualify to be interviewed.

CD’s statement confirmed she was aware of two separate incidents that occurred on the playground on 04/15/22 and 04/18/22 which involved C1 interacting inappropriately with C2 and C1 placed bark down another child’s (C3) pants. CD further claimed that staff did not witness and was unaware of the incident on 04/15/22 until C3’s parents brought the incident to the facility’s attention, although according to one interview, staff was informed of the incident and provided direction to the child. Furthermore, the staff present during the 04/15/22 incident did not produce or provide the parent(s)/authorized representative(s) of the children involved in the incident(s) with a written incident report.

Statements provided by AD, S1, P2 & P3 corroborated all stated incidents involving C1. P2 & P3 stated the facility did not report the occurrence of both incident(s). P2 felt the incident occurred as a result of a lack of supervision while P3 stated that after she obtained knowledge of the incident, she notified the staff on duty of the incident at which time, the staff claimed she did not witness the incident. According to staff interviews, children were always playing with the bark and throwing it requiring staff to provide ongoing supervision. Also, staff are expected rotate or circle around the yard to cover the corners so they could better view the areas and ensure children are not behind trees or hiding under the slide.

On 04/19/22 and 04/20/22, the facility submitted two UIRs which documented the incidents on 04/15/22 and 04/18/22, and on 04/28/22, the facility submitted four incident reports ranging from 08/20/21 through 06/29/22 which documented C1 wrestled with another child over a toy, resulting in C1 putting hands around C4’s neck and choked C4 and another incident regarding C4 getting upset and grabbing another child by the shoulder; close to the neck.

Based on this investigation, the preponderance of evidence standard has been met, therefore the above allegation(s) are found to be SUBSTANTIATED. The facility did not comply with Personal Rights of California Code of Regulations (CCR) 101223(a)(2) & reporting requirements of CCR 101212(f) were previously cited within a 12-month period, therefore, two civil penalties of $250 each are being assessed for a repeat Civil Penalty. Exit interview conducted, and report was reviewed with the Center Director. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. California Code of Regulations, Title 22, Division 12 & Chapter 01, Article 06, are being cited on the attached LIC 9099D. Appeal Rights were provided.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 01-CC-20220421080220
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 483001838
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/12/2022
Section Cited
CCR
101223(a)(2)
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The licensee shall ensure that each child is accorded the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.

This requirement was not met as evidenced by: Based on statements provided by staff and parents which confirmed the facility did not
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CD stated she would produce a written plan detailing how the facility intends to ensure a safer environment while the children on the playground and playing with bark. Center Director stated she would submit her written plan to the Department by 08/12/22 via mail, email or fax.
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maintain a safe environment, resulting in violation of children's personal rights. This posed a potential health,safety and personal rights risk to the children in care and a $250 is being assessed for repeat violation within a 12 months period.
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Email: melchisedeck.augustin@dss.ca.gov
Fax: 707-588-5099
Type B
08/12/2022
Section Cited
CCR
101212(f)
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Reporting Requirements. 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: Based on the investigation, there’s a preponderance of evidence to show the facility
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Center Director stated she would adopt a new method where only the facility management notified and provided parents with incidents and the Director would produce a written plan detailing how the facility intends to comply with CCR 101212(f).
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did not report the occurrence of two incident(s). This posed a potential health,safety and personal rights risk to the children in care and a $250 is being assessed for repeat violation within a 12 month period.
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Email: melchisedeck.augustin@dss.ca.gov
Fax: 707-588-5099
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: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/21/2022 and conducted by Evaluator Melchisedeck Augustin
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20220421080220

FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
483001838
ADMINISTRATOR:FIELDS, DONJEFACILITY TYPE:
850
ADDRESS:35 ROTARY WAYTELEPHONE:
(707) 557-3007
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:72; 72CENSUS: 30DATE:
07/29/2022
UNANNOUNCEDTIME BEGAN:
08:32 AM
MET WITH:Donje Fields - Center Director TIME COMPLETED:
10:00 AM
ALLEGATION(S):
1
2
3
4
5
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7
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9
Daycare child was bitten by another child while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Melchisedeck Augustin conducted an unannounced subsequent complaint-Investigation visit and met with Center Director, Donje Fields (CD) to deliver the finding regarding the above allegation. LPA E. Hernandez-Torres previously met with CD on 04/28/22 to initiate the investigation by discussing the purpose of the visit, conducting interviews with children and CD, and requesting incident reports, and facility roster of the children currently in care. It was alleged that a daycare child was bitten by another child while in care. The report more specifically noted that on an unknown date, a child bit another child (C1) on the thigh.

On 04/28/22, LPA, Hernandez-Torres interviewed CD and two children (C1 & C3). LPA, Augustin interviewed four staff (S1-S3 & AD) and three parents (P1-P3); and reviewed Incident/Accident reports from 04/28/22 through 07/14/22. Some children were not verbal, too young to interview, or did not qualify to be interviewed. (Continue to LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 01-CC-20220421080220
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 483001838
VISIT DATE: 07/29/2022
NARRATIVE
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CD’s statement confirmed that in February 2022, another child (C6) bit C1 on the thigh which left a visible bruise. This incident was incorporated in a prior investigation that resulted in a citation issued on 03/23/22, which was addressed and cleared.

Statements provided by AD and S1 also confirmed that in February or March 2022, C6 bit C1 on the right thigh as described by CD but that the facility hired more qualified staff to provide support and increased supervision to children who exhibited biting behavior(s) in the classroom, resulting in a reduction of biting incidents after 03/23/22. Three statements provided by parents did not have concerns or report any recent biting incident(s) that occurred as a result of lack of supervision.

Based on this investigation, although there have been a few recent biting incidents, there is not a preponderance of evidence to show there is a lack of supervision or that C1 sustained a recent biting occurrence. Therefore, the allegation is unsubstantiated. Exit interview conducted, and report was reviewed with the Center Director. A notice of site visit was given and must remain posted for 30 days. There were no California Code of Regulations, Title 22, Division 12, Chapter 1, Article 06 violation(s) cited during this visit. Appeal Rights were provided.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5