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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334804323
Report Date: 03/08/2024
Date Signed: 03/08/2024 09:06:42 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/02/2024 and conducted by Evaluator Amber Shaw
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20240202165806
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
334804323
ADMINISTRATOR:MARGARITA D. GUILLERMOFACILITY TYPE:
850
ADDRESS:23301 OLIVEWOOD PLAZA DRIVETELEPHONE:
(951) 924-1956
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY:95CENSUS: 30DATE:
03/08/2024
UNANNOUNCEDTIME BEGAN:
08:42 AM
MET WITH:Jessika GuillermoTIME COMPLETED:
09:15 AM
ALLEGATION(S):
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Due to lack of supervision daycare child sustained unexplained injuries while in care
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA), Amber Shaw and Anastasia Flores, made a subsequent unannounced complaint investigation visit to deliver the findings for the above referenced allegations. LPA met with Jessika Guillermo, (Director), who was informed of the decision rendered.

On February 2, 2024, Community Care Licensing (CCL) received a complaint alleging that a child sustained unexplained injuries while in care due to a lack of supervision. During course of investigation, LPA conducted interviews with pertinent parties, including staff and children and was able to obtain information of how the unexplained injury occurred. SEE LIC 9099-C FOR CONTINUATION
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Amber Shaw
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024
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 10-CC-20240202165806
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 334804323
VISIT DATE: 03/08/2024
NARRATIVE
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Interviews revealed that on 01/08/2024, C1 was in the care of S1 and S3, when the injury was likely sustained. According to witnesses, C1 was observed running in the classroom, and somehow tripped and fell for no apparent reason. C1 was immediately tended to by the teacher who provided 1st aid. C1 did not complain of any further pain nor was there any visible injuries and continued with their day. Later that day, S2 was preparing for an activity and when C1 stood up, C1 complained of discomfort and seemed like C1 had trouble putting any weight on their foot so parents were eventually notified. Based on the information obtained, the allegation that C1 sustained an injury due to a lack of supervision is Unsubstantiated.

Exit interview was conducted with Director Jessika Guillermo, Notice of Site Visit was issued and must be posted for 30 days. A copy of this report was provided to the facility. This report must be made available at the facility for 3 years for public review upon request.

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Amber Shaw
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2