334845645-1-5-2023-09-CC-KWIS-CMZTLU-20230112135008

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 334845645
Report Date: 01/05/2023
Date Signed: 01/05/2023 02:30:13 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 ST., SUITE 700
RIVERSIDE, CA 92501

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/28/2022 and conducted by Evaluator Laura Mejorado

COMPLAINT CONTROL NUMBER: 09-CC-20221228091830

FACILITY NAME:	KINGSTON ACADEMY		FACILITY NUMBER:	334845645
ADMINISTRATOR:	KAREN BRAZZILL		FACILITY TYPE:	840
ADDRESS:	6048 ETIWANDA AVENUE		TELEPHONE:	(951) 681-4182
CITY:	MIRA LOMA	STATE: CA	ZIP CODE:	91752
CAPACITY:	49	CENSUS: 13	DATE:	01/05/2023
		UNANNOUNCED	TIME BEGAN:	10:48 AM
MET WITH:	Karen Brazzill		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Other - Licensee does not ensure that motor vehicles used to transport children are in safe operating condition.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Laura Mejorado arrived at the facility to initiate and deliver the findings of this complaint investigation which was initiated today on 01/05/2023. LPA met with Director, Karen Brazzill. LPA toured the facility, took census, and discussed the following with the Director.

During the investigation, LPA made observations, reviewed pertinent documentation and conducted interviews with pertinent parties.

It was alleged, licensee does not ensure that motor vehicles used to transport children are in safe operating condition.

LPA investigated the allegation and gathered the following information:

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 09-CC-20221228091830

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: 01/05/2023

NARRATIVE

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It was reported, licensee does not ensure that motor vehicles used to transport children are in safe operating condition. It was alleged during the month of December 2022 the vehicles used for children transportation were dirty, smelled, had balding tires and needed an oil change. During todays visit LPA inspected the three vans which are used for transporting the school age children. LPA observed vehicles were equipped with seat belts and booster seats. Vehicles have not been used in the last three weeks due to schools being closed for winter break. LPA observed debris on the floor and stains on the seats, LPA discussed with Director who stated vehicles will be cleaned prior to resuming transportation services. During interviews it was disclosed if a vehicle needs maintenance or repair, management is made aware verbally and via documentation. During inspection LPA reviewed vehicle maintenance log which documented new tires were installed on the vehicles on 01/04/2023 and history of oil changes. Per facility staff vehicles are scheduled to have an oil change this weekend.

Based on information obtained during this investigation through interviews conducted, the review of pertinent documentation, and after receiving conflicting information, the allegation is UNSUBSTANTIATED. A finding that the allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation occurred.

An exit interview was conducted with the Director, Appeal Rights were discussed and issued, a copy of this report was provided, and a Notice of Site visit was issued.

The Notice of Site Visit (LIC 9213) shall be posted where the parent/guardian of children enter and exit the facility. The Notice of Site Visit (LIC 9213) must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

A copy of this report must be made available for the next three years.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2023

LIC9099 (FAS) - (06/04)

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