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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013412609
Report Date: 11/02/2022
Date Signed: 11/02/2022 01:30:36 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, 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
08/23/2022 and conducted by Evaluator Simerjit Kaur
COMPLAINT CONTROL NUMBER: 52-CC-20220823123551
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
013412609
ADMINISTRATOR:CATHERINE BOLLINGERFACILITY TYPE:
840
ADDRESS:4655 LASSEN ROADTELEPHONE:
(925) 455-1560
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY:48CENSUS: 0DATE:
11/02/2022
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Jamie CzelusniakTIME COMPLETED:
01:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights: Day care child received an injury while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11/2/2022, Licensing Program Analyst (LPA) Simerjit Kaur met with Director Jamie Czelusniak for the purpose of an UNANNOUNCED COMPLAINT INSPECTION. Present for this inspection was the Director, 1 staff, and no school age children. LPA obtained copy of personnel roster and children's roster.

The allegation that day care child received an injury while in care has been SUBSTANTIATED. Based on evidence gathered, record review, and interviews conducted, the standard has been met, therefore the above allegation is found to be SUBSTANTIATED.
Health and Safety Code section 1596.80 is being cited on the attached LIC 9099D. A copy of this report, and Appeal Rights provided. Notice of site visit provided. An exit interview is conducted.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
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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