334804328-8-30-2021-10-CC-SHUK-C6FS3L-20210901133116

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 334804328
Report Date: 08/30/2021
Date Signed: 08/30/2021 12:27:47 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/08/2021 and conducted by Evaluator Alaina Wilburn

PUBLIC

COMPLAINT CONTROL NUMBER: 10-CC-20210608153808

FACILITY NAME:	KINDERCARE LEARNING CENTER		FACILITY NUMBER:	334804328
ADMINISTRATOR:	RAMOS, SONG		FACILITY TYPE:	830
ADDRESS:	42111 FLORIDA AVENUE		TELEPHONE:	(951) 927-8194
CITY:	HEMET	STATE: CA	ZIP CODE:	92544
CAPACITY:	20	CENSUS: 7	DATE:	08/30/2021
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Patricia Gibson		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff did not feed infant.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Alaina Wilburn conducted an unannounced complaint visit. LPA met with Acting Assistant Director Patricia Gibson, to deliver findings on the above stated allegation.

Investigation consisted of interviews with Director and a witness. LPA also reviewed relevant paperwork and obtained a Declaration from the Assistant Director, assigned Teacher and Teacher's Assistant

Investigation revealed the following: On April 29, 2021, it was alleged Child #1 (C1) was not given any fluids (milk/formula), as C1 was picked up from day care with full bottles of unused milk. All facility staff deny allegation, and stated C1 was brought with only one bottle and containers of pureed fruits and vegetables on that day. Staff advised that in addition to the available food, C1 was given water throughout the day. The facility does not document water consumption on daily reports. In addition to the water given, staff advised and documented C1 was given 1 jar of squash and 1 jar of applesauce for breakfast, some bread, 1 jar of carrots and 1 jar of squash for lunch and 1 jar of applesauce for an afternoon snack. C1 was also offered

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Hudak
LICENSING EVALUATOR NAME: Alaina Wilburn
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021

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 3

Control Number 10-CC-20210608153808

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: KINDERCARE LEARNING CENTER	FACILITY NUMBER: 334804328
	VISIT DATE: 08/30/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

strawberries and corn during lunch, but the child did not consume any.

Based on interviews with staff, witness and record review, the allegation that facility did not feed infant may have happened or is valid, but there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is unsubstantiated at this time.

Exit interview conducted and a copy of the report along with the appeal rights were provided to Acting Assistant Director Patricia Gibson.

A NOTICE OF SITE VISIT WAS ISSUED AND LPA VERIFIED THAT IT WAS POSTED IN A PROMINENT LOCATION AT THE FACILITY BEFORE LEAVING. THE LICENSEE UNDERSTANDS THAT IT MUST REMAIN POSTED FOR THE NEXT 30 DAYS

SUPERVISORS NAME: Stephanie Hudak
LICENSING EVALUATOR NAME: Alaina Wilburn
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3