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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 103810078
Report Date: 10/27/2021
Date Signed: 10/27/2021 10:04:11 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/21/2021 and conducted by Evaluator Nancy Her
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20210921085100
FACILITY NAME:KING'S CORNER CHILDCARE, LLCFACILITY NUMBER:
103810078
ADMINISTRATOR:DIANA MEJIAFACILITY TYPE:
840
ADDRESS:1080 N CHESTNUT AVETELEPHONE:
(559) 374-8577
CITY:FRESNOSTATE: CAZIP CODE:
93702
CAPACITY:49CENSUS: 17DATE:
10/27/2021
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:TIME COMPLETED:
10:15 AM
ALLEGATION(S):
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Staff did not conduct proper enrollment procedures with child's authorized representatives.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nancy Her arrived at the facility to conduct an unannounced follow-up complaint inspection. LPA Met with Director Diana Mejia and Assistant Director Lindsi Pipken. The purpose of the inspection was to deliver the findings for the complaint alleging staff did not conduct proper enrollment procedures with child's authorized representatives.
During the course of the investigation, LPAs conducted interviews with the Licensee and the complainant. Based on the information obtained during the investigation, the preponderance of evidence standard has been met. Therefore, the allegation that staff did not conduct proper enrollment procedures with child's authorized representatives is found to be substantiated.

Per California Code of Regulations, Title 22, Division 12, Chapter 1, the following deficiencies are being cited during today's visit.

An exit interview conducted with Director Diana Mejia.
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Nancy Her
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021
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 2
Control Number 04-CC-20210921085100
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: KING'S CORNER CHILDCARE, LLC
FACILITY NUMBER: 103810078
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/27/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/05/2021
Section Cited
CCR
101221(e)
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101221 Child's Records (e) A child's records shall also be open to inspection by the child's authorized representative. This requirement was not met as evidenced by record review and interviews conducted.
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Director will conduct staff training on court orders and adhere to any future court orders recieved.
Type B
11/05/2021
Section Cited
CCR
101218.1(b)
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101218.1 Admission Procedures and Parental and Authorized Representative's Rights (b) At the time of acceptance of each child in care, the licensee shall inform each child's parent or authorized representative of his/her rights.
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Director will provide all parents and/or authorized representative of his/her rights.
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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.
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Nancy Her
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021
LIC9099 (FAS) - (06/04)
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