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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334845644
Report Date: 03/14/2022
Date Signed: 03/14/2022 12:10:11 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/07/2022 and conducted by Evaluator Justin Giese
COMPLAINT CONTROL NUMBER: 09-CC-20220207141915

FACILITY NAME:KINGSTON ACADEMYFACILITY NUMBER:
334845644
ADMINISTRATOR:LIANG, HANBOFACILITY TYPE:
850
ADDRESS:6048 ETIWANDA AVENUETELEPHONE:
(951) 681-4182
CITY:MIRA LOMASTATE: CAZIP CODE:
91752
CAPACITY:72CENSUS: DATE:
03/14/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:TIME COMPLETED:
12:25 PM
ALLEGATION(S):
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Staff left daycare children unattended
INVESTIGATION FINDINGS:
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On 03/14/22 at 10:30 am Licensing Program Analyst (LPA) Justin Giese made an unannounced visit to the facility for the purpose of concluding a complaint investigation. LPA met with Director, Karen Brazzill, regarding the above allegation, which was received on 02/07/2022.

The following was alleged: Staff left daycare children unattended

On 02/14/2022, LPA made an unannounced visit to the facility for the purpose of investigating the above allegation. LPA received two written statements from facility Director and staff involved acknowledging two separate incidents where children were left unattended. Written statements provided corroborated what was alleged.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Justin Giese
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 09-CC-20220207141915
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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: KINGSTON ACADEMY
FACILITY NUMBER: 334845644
VISIT DATE: 03/14/2022
NARRATIVE
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The first occurrence was documented on 01/26/2022. Staff escorted six children from the playground to the indoor facility restroom. When the staff member returned to the playground only five children were present. Minutes passed before the missing child was discovered in the facility restroom.

The second occurrence was documented on 02/03/2022. Facility Director observed a staff member escorted seven children from the conjoined Kinder classroom into the 2’s and 3’s classroom through the side classroom door which connects the two classrooms together. Moments after staff shut the door, an additional child opened the door from the kinder class and entered the 2’s and 3’s class. Staff left the child unattended when transitioning between rooms.

Based on LPAs interviews and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Please see attached LIC9099D for Type A Deficiency

A Civil Penalty of $500 will be assessed during this investigation for failing to Provide Care and Supervision. Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”.

An exit interview was conducted, and LPA provided the Director with a copy of this report on 03/14/2022.

LPA issued a Notice of Site Visit and verified it was posted in a prominent location at the facility. Licensees understands that the Notice of Site Visit must remain posted for the next 30 days along with a copy of all Type A deficiencies cited during this inspection. A copy of all Type A deficiencies cited during this inspection must also be immediately (within 24 hours of child’s next day in care) given to the parents of all children enrolled in the child care facility and any children enrolled into the child care facility over the next 12 months (at the time of enrollment). Licensees are required to have all parents sign and date the Acknowledgement of Receipt of Licensing Reports (LIC9224) and maintain a copy in each child’s file. A copy of this report, LIC9224 and Appeal Rights (LIC9058) were provided during this inspection.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Justin Giese
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 09-CC-20220207141915
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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KINGSTON ACADEMY
FACILITY NUMBER: 334845644
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/15/2022
Section Cited
CCR
101229(a)(1)
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Responsibility for Providing Care and Supervision - No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation.

This requirement has not been met as evidenced by:
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IMMEDIATE CIVIL PENALTY OF $500 WILL BE ASSESSED for failing to Provide Care and Supervision

Facility Director understands the importance of providing care and supervision for children in care at all times. Facility director will conduct a training session with staff and submit the outline
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Based on Interviews and records reviewed, on 01/26/2022 Staff left a child in the Facility's restroom unattended. On 02/03/2022 Staff left a child unattended while transitioning other children from one classroom to another. This poses an immediate health and safety risk to the children in care.
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of topics discussed regarding care and supervision with emphasis on transitioning children between indoor/outdoor spaces and toileting. Documentation of training/proof of correction will need to be submitted to LPA on or before the date of correction, 03/15/2021.
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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: Gilbert Sena
LICENSING EVALUATOR NAME: Justin Giese
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2022
LIC9099 (FAS) - (06/04)
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