490110440-3-12-2021-01-CC-AHON-BZ5TNR-20210315145307

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 490110440
Report Date: 03/12/2021
Date Signed: 03/12/2021 03:15:56 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/19/2020 and conducted by Evaluator Jennifer Velasco

PUBLIC

COMPLAINT CONTROL NUMBER: 01-CC-20201019102407

FACILITY NAME:	LEARNING TO LEARN PRESCHOOL & CCC		FACILITY NUMBER:	490110440
ADMINISTRATOR:	KADE, KATHLEEN		FACILITY TYPE:	850
ADDRESS:	391 MARIA DRIVE		TELEPHONE:	(707) 762-8607
CITY:	PETALUMA	STATE: CA	ZIP CODE:	94954
CAPACITY:	100	CENSUS:	DATE:	03/12/2021
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Kathleen Kade		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Day care child sustained an injury.
Staff did not obtain emergency treatment for day care child.

INVESTIGATION FINDINGS:

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Due to the COVID-19 public health emergency, an unannounced tele-visit was conducted by Licensing Program Analyst Jennifer Velasco (LPA), who met with Director Kathleen Kade (D1). It was alleged that a child (C1) sustained injury while in care; specifically, C1 was bitten by a bat on the playground. It was further alleged that staff did not obtain emergency treatment for day care child; specifically, staff failed to notify C1’s authorized representative or obtain medical care for C1 when C1 became injured. On 10/21/2020, LPA interviewed two adults and one child. During the 10/22/2020 announced initial complaint investigation tele-visit, LPA interviewed one adult and requested pertinent facility documents. Upon receipt of said documents, LPA conducted document review. LPA interviewed two adults on 03/01/2021. Documentation and witness statements corroborate the allegations that a child sustained injury in care and staff did not obtain emergency treatment for the child. Based on interviews and facility documents, the preponderance of evidence standard has been met; therefore, the above allegations are found to be substantiated. This report was reviewed and discussed with D1. D1’s original signature was not recorded on this report; however, D1 was provided with a copy of the LIC9099 Complaint Investigation Report (CIR) and Appeal Rights in an email dated 03/12/2021 and confirmation of read receipt of the CIR is on file. The following violations of the California Code of Regulation, Title 22, were cited: See attached LIC9099-D.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Jennifer Velasco	TELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2021

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 01-CC-20201019102407

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: LEARNING TO LEARN PRESCHOOL & CCC	FACILITY NUMBER: 490110440
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/12/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/09/2021 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	The licensee shall provide care and supervision as necessary to meet the children's needs. Tht as evidenced by: multiple witness statements and documentation demonstrating a child sustained injury while in care without	1 2 3 4 5 6 7	Director (D1) stated they will conduct staff training on constant visual supervision of each child and will provide LPA with the detailed agenda and sign-in sheet by email on or before the POC date of 04/09/2021.
	8 9 10 11 12 13 14	staff observing the incident that resulted in injury.	8 9 10 11 12 13 14	LPA email: jennifer.velasco@dss.ca.gov
Type B 03/12/2021 Section Cited CCR 101226(b)	1 2 3 4 5 6 7	Health-Related Services The licensee shall immediately notify the child's authorized representative if the child becomes ill or sustains an injury more serious than a minor cut or scratch. This requirement is not met as evidenced by: multiple	1 2 3 4 5 6 7	Director (D1) stated they will conduct staff training on health-related services, notification requirements, and bat safety guidance and will email to LPA on or before the POC date of 04/09/2021 the detailed agenda for each topic and the sign-in sheet.
	8 9 10 11 12 13 14	witness statements demonstrating staff did not notify a child’s authorized representative when the child told staff about a bat biting the child.	8 9 10 11 12 13 14	LPA email: jennifer.velasco@dss.ca.gov

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: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Jennifer Velasco	TELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2021

LIC9099 (FAS) - (06/04)

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