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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013412608
Report Date: 03/22/2021
Date Signed: 03/22/2021 01:41:34 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/28/2021 and conducted by Evaluator Lisa Clayton
COMPLAINT CONTROL NUMBER: 52-CC-20210128092751
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
013412608
ADMINISTRATOR:KATHARINE STAUFFERFACILITY TYPE:
850
ADDRESS:4655 LASSEN ROADTELEPHONE:
(925) 455-1560
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY:72CENSUS: DATE:
03/22/2021
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Catherine Bollinger,
Director Diane Palacios,
District Leader 		TIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Lack of Supervision


INVESTIGATION FINDINGS:
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03/22/2021, at approximately 10:00 am, LPA Clayton, LPA Dacanay-Breaux, Regional Manager Anika Evans, LPM Chandra Charles, District Leader Diane Palacios, Director Cathering Bollinger, Director Eva Prado, and Regional Quality Business Partner Judy Werkheiser met for a Non-Compliance Conference during which we also concluded the Complaint regarding Lack of Supervision allegations of January 25, 2021.

Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12, Chapter 1), are being cited on the attached LIC. 9099D.”

Exit interview conducted, Notice of Site Visit and Appeal rights were provided. The attached type A deficiencies are cited today and must be corrected by the due dates. Upon receipt, licensee shall post and provide copies of this licensing report to parent/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lisa ClaytonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2021
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 4
Control Number 52-CC-20210128092751
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 013412608
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/22/2021
Section Cited
CCR
101229(a)(1)
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Responsibility for Providing Care and Supervision:
a) The licensee shall provide care and supervision as necessary to meet the children's needs.

(1) No child(ren) shall be left without the supervision of a teacher at any time,
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District Leader submitted a written plan to bring the facility into compliance which includes training to ensure that children are supervised at all times. Documentation was submitted in the Non-Compliance meeting.
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except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.

This requirement was not met as evidenced by: Based on interviews, records review, and photos of C1, Lack of Supervision was substantiated.
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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: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lisa ClaytonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/28/2021 and conducted by Evaluator Lisa Clayton
COMPLAINT CONTROL NUMBER: 52-CC-20210128092751

FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
013412608
ADMINISTRATOR:KATHARINE STAUFFERFACILITY TYPE:
850
ADDRESS:4655 LASSEN ROADTELEPHONE:
(925) 455-1560
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY:72CENSUS: DATE:
03/22/2021
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Catherine Bollinger,
Director Diane Palacios,
District Leader 		TIME COMPLETED:
01:45 PM
ALLEGATION(S):
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5
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7
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9
Reporting requirements not met
INVESTIGATION FINDINGS:
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03/22/2021, at approximately 10:00 am, LPA Clayton, LPA Dacanay-Breaux, Regional Manager Anika Evans, LPM Chandra Charles, District Leader Diane Palacios, Director Cathering Bollinger, Director Eva Prado, and Regional Quality Business Partner Judy Werkheiser met for a Non-Compliance Conference during which we also concluded the Complaint regarding Reporting requirements not met allegations of January 25, 2021.

Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12 Chapter 1 101212), are being cited on the attached LIC. 9099D.”
A Type B violation is being cited for Non-Complaince of Reporting to Licensing according to licensing policy and procedures.

Exit interview conducted, Notice of Site Visit and Appeal rights were provided.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lisa ClaytonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 52-CC-20210128092751
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 013412608
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/22/2021
Section Cited
CCR
101212
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Reporting Requirements:
(d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In
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 District Leader conducted staff meetings and virtual training to review self-reporting and documenting.
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addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.
This requirement was not met by:
There was no Unusual Incident Report filed with licensing within a timely manner.
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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: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lisa ClaytonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4