<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073401317
Report Date: 01/23/2023
Date Signed: 01/23/2023 04:23:51 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, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/04/2022 and conducted by Evaluator Nyeesha Blount
COMPLAINT CONTROL NUMBER: 02-CC-20221004153353
FACILITY NAME:KINDERCARE LEARNING CENTER, #1367FACILITY NUMBER:
073401317
ADMINISTRATOR:BETTS, LAWANDAFACILITY TYPE:
830
ADDRESS:3240 SAN PABLO DAM ROADTELEPHONE:
(510) 222-1144
CITY:SAN PABLOSTATE: CAZIP CODE:
94806
CAPACITY:33CENSUS: DATE:
01/23/2023
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:BETTS, LAWANDA TIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights ~ Day-care child sustained multiple injuries while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
THIS IS AN AMENDED REPORT FROM THE ORIGINAL REPORT DATED 12/30/22.

On January 19, 2023 Licensing Program Analyst Nyeesha Blount conducted an unannounced complaint Investigation inspection, LPA met with Director Betts, Wanda Present during the visit were (4) staff members,(16) Infant children. A health and safety inspection was conducted.

During the investigation LPAs conducted interviews and reviewed documents. Based on interviews conducted it is determined that staff could not recall when and how the above allegation occurred, Which caused injury to child in care.

Based on interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is to be substantiated.
Substantiated
Estimated Days of Completion: 60
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Nyeesha BlountTELEPHONE: (510) 566-2319
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023
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 02-CC-20221004153353
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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: KINDERCARE LEARNING CENTER, #1367
FACILITY NUMBER: 073401317
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/23/2023
Section Cited
CCR
101223(a)(2)
1
2
3
4
5
6
7
101223(a)(2) Personal Rights The licensee shall ensure that each child is accorded the following personal rights:
(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
CHILD SUSTAINED MULTIPLE INJURIES WHILE IN CARE.

This requirement is not met as evidenced by interviews conducted

This poses a potential risk for the health and safety of children in care.
1
2
3
4
5
6
7
POC by February 3, 2023, A written plan of action will be sent to Licensing detailing the steps staff will take to ensure incidents are properly noted and reported to parents. upon occurrence while children are in care. Also have staff complete a statement of acknowledgement.
8
9
10
11
12
13
14
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Nyeesha BlountTELEPHONE: (510) 566-2319
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4