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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304371091
Report Date: 12/02/2021
Date Signed: 12/02/2021 05:27:05 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/12/2021 and conducted by Evaluator Nguyen K Tran
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20211012133627
FACILITY NAME:KINDERLAND ACADEMYFACILITY NUMBER:
304371091
ADMINISTRATOR:SALCEDO, MIRIAMFACILITY TYPE:
850
ADDRESS:1170 W. CIVIC CENTER DRIVETELEPHONE:
(714) 280-4222
CITY:SANTA ANASTATE: CAZIP CODE:
92703
CAPACITY:42CENSUS: 27DATE:
12/02/2021
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Miriam Salcedo, AdministratorTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Facility is operating beyond the scope of their license.
INVESTIGATION FINDINGS:
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On 12/02/2021, Licensing Program Analyst (LPA) Tran conducted a in person inspection to deliver the findings regarding the above complaint allegation. LPA Tran met with Director Miriam Salcedo. The Covid-19 Emergency Response questionnaires were asked. A tour of the facility was conducted, and a census was taken. Observed at the time of the visit was a total of 8 preschool with 1 staff in Little Stars classroom, 11 preschool children and 2 staff in Little Adventurers class room, and 8 school age children and 1 staff in the Super Rockets classroom. A review of staff criminal clearance records on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 10/12/2021, the office received a complaint alleging facility is operating beyond the scope of their license. Reporting Party (RP) disclosed that child #1 (C1) enrolled at facility at 18 months old.

(Continue next page)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021
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 6
Control Number 06-CC-20211012133627
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: KINDERLAND ACADEMY
FACILITY NUMBER: 304371091
VISIT DATE: 12/02/2021
NARRATIVE
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(Page 2 of Report)

During the investigation, Licensing Program Analyst (LPA) interviewed three staff members, six parents, 3 children, reviewed facility roster, children and staff files, classes’ schedules and facility accident/incident report.
During the staff interview, one of the three interviewed staff admitted that they had accepted two children, who were under the age of two, to be enrolled in the Little Adventurers classroom at the facility. Record reviewed indicated two children, C1 was enrolled at 18 months old, and C7 was enrolled at 19 months old.

Based on the information gathered from LPA’s interviews and reviewing records, the preponderance of evidence standard has been met, therefore the allegation regarding facility operates beyond its scope is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division & Chapter 1, Section 101161 Limitations on Capacity (a) A licensee shall not operate a childcare center beyond the conditions and limitations specified on the license, including the capacity limitation, is being cited on the attached LIC9099D.

Exit interview was conducted. The Notice of Site Visit was posted. Facility representative was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalty of $100. This report LIC 9099 and appeal rights were provided to the director. First level appeal is to Regional Manager, address is above on the report.


(End of Report)
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 06-CC-20211012133627
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: KINDERLAND ACADEMY
FACILITY NUMBER: 304371091
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/02/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/02/2021
Section Cited
CCR
101161(a)
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101161 Limitations on Capacity and Ambulatory Status (a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.

This requirement was not met evidenced by:
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Administrator will provide a statement of acknowledgement of the regulation 101161(a) and a plan to not repeat this violation.
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Based on interviews and record reviews, facility has enrolled two children under the age of two in Little Aventurers classroom, C1 was enrolled at 18 months old, and C7 was enrolled at 19 months old, which poses a potential risk to the health and safety of children in care.
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Statement of acknowledgement of the regulation and written plan from Administrator was obtained on this day.
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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: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/12/2021 and conducted by Evaluator Nguyen K Tran
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20211012133627

FACILITY NAME:KINDERLAND ACADEMYFACILITY NUMBER:
304371091
ADMINISTRATOR:SALCEDO, MIRIAMFACILITY TYPE:
850
ADDRESS:1170 W. CIVIC CENTER DRIVETELEPHONE:
(714) 280-4222
CITY:SANTA ANASTATE: CAZIP CODE:
92703
CAPACITY:42CENSUS: 27DATE:
12/02/2021
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Mariam Salcedo, AdministratorTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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9
Facility is operating out of ratio.
Facility staff are not properly supervising children.
Facility staff are not notifying children's representatives of unusual incidents.
INVESTIGATION FINDINGS:
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On 12/02/2021, Licensing Program Analyst (LPA) Tran conducted a in person inspection to deliver the findings regarding the above complaint allegation. LPA Tran met with Director Mariam Salcedo. The Covid-19 Emergency Response questionnaires were asked. A toured the facility was conducted, and a census was taken. Observed at the time of the visit was a total of 8 preschool with 1 staff in Little Stars classroom, 11 preschool children and 2 staff in Little Adventurers class room, and 8 school age children and 1 staff Super Rockets classroom. A review of staff criminal clearance records on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 10/12/2021, the office received a complaint alleging, facility is operating out of ratio, facility staff are not properly supervising children, and facility staff are not notifying children's representatives of unusual incidents.

(Continue next page)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 06-CC-20211012133627
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: KINDERLAND ACADEMY
FACILITY NUMBER: 304371091
VISIT DATE: 12/02/2021
NARRATIVE
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(Page 2 of Additional Report)

Reporting Party (RP) disclosed that staff was not properly supervising the children and had witnessed 2 staff supervising more than 24 children on the playground. The RP also reported that children had scratches, bruises, and bites and there was no notification provided. Staff would only explain what happened if they were questioned about the injuries. According to RP, staff was not consistent when reported about how injury occurred.

During the investigation, Licensing Program Analyst (LPA) interviewed three staff members, six parents, 3 children, reviewed facility roster, children and staff files, classes’ schedules and facility accident/incident report.
During the staff interview, all three interviewed staff confirmed that there’s only one class with 12 children that can use the playground at a scheduled time. The classrooms are not sharing the playground. All three staff stated that there was supervision provided at all time for the children. If one staff or child needs to use the restroom, another staff will come to ensure supervision provided. During record review, class schedules showed that at no time during the day that the playground was shared by 2 classes. Schedules show that playground are utilized as followed: 9:45am-10:25am Little Adventurers, 10:30am-11am Little Stars, 12:30pm-2pm Super Rockets, 3:15pm-4:15pm Little Adventurers, 4:14pm-5pm Little Stars.

All three interviewed staff confirmed that when the children have an accident or an incident happened to the children, staff would follow the procedure to inform parents right away. Ouch report would be provided to parents as needed. Staff 3 (S3) disclosed on 9/23/21, S3 witnessed Child 1 (C1) was playing on the slide with C3. C1 fell down and hurt C1’s ankle. Record showed facility completed the Ouch Report and C1’s mother signed the Ouch Report acknowledging she’d received the Ouch Report. Children’s file review also showed that facility kept copy of accident/incident reports which have parent’s signature on the form. Each incident report shows the exact date of the incident and has parent’s signature on the same date, except 1 incident/accident report has parent’s signature on the next day.

On 10/18/2021, LPA interviewed three children. All three interviewed children confirmed that they have never shared the playground with other children who are in other classes. All three interviewed children stated there are always staff supervising children.
(Continue next page)
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 06-CC-20211012133627
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: KINDERLAND ACADEMY
FACILITY NUMBER: 304371091
VISIT DATE: 12/02/2021
NARRATIVE
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On 11/08/2021, LPA Tran contacted eight parents by phone and was able to interview six parents. All six interviewed parents stated their children are happy and like to go the facility. There was no concern.

Based on the information gathered from LPA’s interviews and records review, there is insufficient evidence to corroborate the allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged of facility is operating out of ratio, facility staff are not properly supervising children, facility staff are not notifying children's representatives of unusual incidents, did or did not occur, therefore the listed allegations are UNSUBSTANTIATED.


Exit interview was conducted. The Notice of Site Visit was posted. Facility representative was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalty of $100. This report LIC 9099 and appeal rights were provided to the director. First level appeal is to Regional Manager, address is above on the report.

(End of Additional Report)

SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021
LIC9099 (FAS) - (06/04)
Page: 6 of 6