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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198018944
Report Date: 11/16/2020
Date Signed: 11/16/2020 10:54:29 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/02/2020 and conducted by Evaluator Judy Mora
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20200602152618
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
198018944
ADMINISTRATOR:MARYAM MASSOUDIFACILITY TYPE:
830
ADDRESS:1650 STONER CREEK RD.TELEPHONE:
(626) 965-3550
CITY:CITY OF INDUSTRYSTATE: CAZIP CODE:
91748
CAPACITY:32CENSUS: 5DATE:
11/16/2020
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Maryam Massoudi TIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Child sustained multiple unexplained injuries, including burn marks, while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Judy Mora conducted a complaint inspection to conclude the investigation in regards to the above complaint allegation. LPA met with, Director Maryam Massoudi. This complaint investigation was completed by the Department’s Investigation’s Branch.

During the course of the investigation, interviews were conducted with facility staff, children, subject of the investigation and other witnesses. A facility roster and an Identification and Emergency form for the alleged victim was obtained during the investigation. There were no disclosures made during interviews and there were no eyewitnesses who could identify or explain how the child sustained the injuries in question.

Although the allegation may have happened or is valid there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

*REPORT CONTINUES ON NEXT PAGE

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2020
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 33-CC-20200602152618
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 198018944
VISIT DATE: 11/16/2020
NARRATIVE
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The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview conducted with Director. Appeal Rights explained and provided to the director during this visit.




*END
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2