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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334845645
Report Date: 11/14/2022
Date Signed: 11/14/2022 01:59:46 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
09/21/2022 and conducted by Evaluator Giselle Carbullido
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20220921101600
FACILITY NAME:KINGSTON ACADEMYFACILITY NUMBER:
334845645
ADMINISTRATOR:KAREN BRAZZILLFACILITY TYPE:
840
ADDRESS:6048 ETIWANDA AVENUETELEPHONE:
(951) 681-4182
CITY:MIRA LOMASTATE: CAZIP CODE:
91752
CAPACITY:49CENSUS: 0DATE:
11/14/2022
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Karen BrazzillTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Facility co-mingled day care children while in care.
Staff did not properly supervise day care children while in care.
INVESTIGATION FINDINGS:
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On the date and time listed above, Licensing Program Analyst (LPA) Giselle Carbullido arrived at the facility to conduct an investigation regarding the above complaint received on 09/21/22. LPA was given access to the facility by Karen Brazzill. On 09/27/2022 an initial inspection was completed; interviews were conducted, and records were obtained. LPA toured the facility and took census. LPA met with the Director to discuss the complaint allegations and deliver findings
Summary of findings for the following allegations:
Facility co-mingled day care children while in care. It was reported that a school age children co-mingled in the preschool room. LPA interviewed 3 staff. Staff interviews disclosed a waiver for first and last hour of operational hours and stated school age have been in the preschool room which did result in a behavior incident for a school age child. Additionally, video review from 09/19/2022 depicts school age child in the preschool room during nap time.

Staff did not properly supervise day care children while in care. It was reported that a behavior incident occurred
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 7
Control Number 09-CC-20220921101600
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: 334845645
VISIT DATE: 11/14/2022
NARRATIVE
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due to school age child in the preschool room and without proper supervision. LPA observed a video clip from 09/19/2022 that depicts a school age child in the preschool room disrupting nap time by invading the space of a preschool child. Video further reveals a facility staff in the room failing to address the school age child now engaged in laying on preschool child’s cot, pulling preschool child’s blanket and then wrestling with preschool child.

Based on interviews conducted and documents reviewed, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED per California Code of Regulations, Title 22, Division 12. See LIC9099D for cited deficiencies.



LPA Carbullido informed Karen Brazzill this report documents two Type A citations, which shall be posted for 30 consecutive days, as there was an immediate risk to the health, safety, or personal rights of children in care.

LPA Carbullido informed Karen Brazzill to provide a copy of this licensing report to parents/guardians of all children currently enrolled by the next business day, or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

An exit interview was conducted, and appeal rights discussed. A copy of this report, Notice of Site Visit, and appeal rights were provided to Karen Brazzill. This report must be made available to the public upon request for three years.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 7
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
09/21/2022 and conducted by Evaluator Giselle Carbullido
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20220921101600

FACILITY NAME:KINGSTON ACADEMYFACILITY NUMBER:
334845645
ADMINISTRATOR:KAREN BRAZZILLFACILITY TYPE:
840
ADDRESS:6048 ETIWANDA AVENUETELEPHONE:
(951) 681-4182
CITY:MIRA LOMASTATE: CAZIP CODE:
91752
CAPACITY:49CENSUS: 0DATE:
11/14/2022
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Karen Brazzill, DirectorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff yelled and spoke inappropriately to a child while in care.
Staff discriminated against day care child while in care
Staff did not treat day care child with respect while in care.
INVESTIGATION FINDINGS:
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On the date and time listed above, Licensing Program Analyst (LPA) Giselle Carbullido arrived at the facility to conduct an investigation regarding the above complaint received on 09/21/22. LPA was given access to the facility by Director Karen Brazil. On 09/27/2022 an initial inspection was completed; interviews were conducted, and records were obtained. LPA toured the facility and took census. LPA met with the Director to further discuss the complaint allegations and deliver findings.

Summary of finding for the following allegations:
Staff yelled and spoke inappropriately to a child while in care. It was reported that staff yelled “I’m so sick of you” to a child.
Staff did not treat day care child with respect while in care. It was reported that staff treated more harshly and meanly than others while in care.
Staff discriminated against day care child while in care. It was reported that staff did not allow child to play with toys.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 09-CC-20220921101600
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: 334845645
VISIT DATE: 11/14/2022
NARRATIVE
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During the investigation, LPA interviewed six staff and four children. Staff interviews reported conflicting information or negated the aforementioned allegations above. Children interviews denied observing others or themselves being discriminated against, treated differently, yelled at, or spoken to inappropriately at the facility.

Therefore, the evidence collected was not sufficient to substantiate or refute the above allegation. 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.

An exit interview was conducted, a copy of this report and Notice of Site Visit was provided to the Director. LPA observed the Notice of Site Visit was posted by staff. THIS REPORT MUST BE AVAILABLE TO THE PUBLIC FOR THREE YEARS

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 09-CC-20220921101600
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: 334845645
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/15/2022
Section Cited
CCR
101229(a)
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Responsibility for Providing Care and Supervision 101229(a) The licensee shall provide care and supervision as necessary to meet the children's needs.

This requirement is not met as evidenced by:
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Facility Director will submit proof of training for all staff on CCR 101229 to the Department by POC due date of 11/15/22
Facility wiil completed required LIC9924 signature pages for all children in care.
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Based on video review facility did not meet the section above in that a teacher failed to redirect a school age child from invading the personal space and getting on the cot of another child in the preschool program. This is an immediate health and safety risk to persons in care.
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Type A
11/15/2022
Section Cited
CCR
101538.3(b)
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Indoor Activity Space for School-Age Children-101538.3(b) -In combination programs, indoor activity space provided for school-age child care center children shall be physically separated from space provided for infant care and child care center children. This requirement is not met as evidenced by:
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Facility Director will submit letter of understanding for CCR101538.3(b) including in-service with staff on review of regulation 101538.3(b) to the Department by POC due date of 11/15/22.
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Based on video review and interviews conducted, facility did not meet the section above in that a school age child was observed in the preschool room during nap time. This is an immediate health and safety risk to persons in care.
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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: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022
LIC9099 (FAS) - (06/04)
Page: 7 of 7