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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334845646
Report Date: 09/03/2025
Date Signed: 09/03/2025 06:01:46 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 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
08/26/2025 and conducted by Evaluator Laura Mejorado
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20250826090243
FACILITY NAME:KINGSTON ACADEMYFACILITY NUMBER:
334845646
ADMINISTRATOR:KAREN BRAZZILLFACILITY TYPE:
830
ADDRESS:6048 ETIWANDA AVENUETELEPHONE:
(951) 681-4182
CITY:MIRA LOMASTATE: CAZIP CODE:
91752
CAPACITY:20CENSUS: 4DATE:
09/03/2025
UNANNOUNCEDTIME BEGAN:
10:23 AM
MET WITH:Jennifer House, Facility RepresentativeTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Qualifications - Staff does not have required units
INVESTIGATION FINDINGS:
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On this date and time, Licensing Program Analysts (LPAs) Laura Mejorado and Tiffanie Diep arrived at the facility to initiate a complaint investigation, in regard to the above allegation. LPAs met with facility representative Jennifer House, toured the facility, took census, conducted interviews and discussed the following.

During the investigation, LPAs made observations, reviewed pertinent documentation, and conducted interviews with pertinent parties. It was alleged, a staff does not have the required units. LPAs investigated the allegation and gathered the following information:

Please see LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
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 5
Control Number 09-CC-20250826090243
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: KINGSTON ACADEMY
FACILITY NUMBER: 334845646
VISIT DATE: 09/03/2025
NARRATIVE
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It was reported, a staff member may be working in the infant classroom with out infant units. While conducting interviews it was disclosed a staff member (S1) has been working as a floater covering breaks in the infant classroom. After conducting a review of S1s file, it was determined they did not have the necessary units needed to work in the infant classroom.

Based on LPAs interviews, and record review, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12 & Chapter 1), are being cited on the attached LIC9099D.


A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the facility representative Jennifer House.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 09-CC-20250826090243
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KINGSTON ACADEMY
FACILITY NUMBER: 334845646
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/08/2025
Section Cited
CCR
101416.2(b)
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(b) Prior to employment, an infant care teacher shall have completed, with passing grades, at least three postsecondary semesters or equivalent quarter units in early childhood education or child development, and three postsecondary semester or equivalent quarter units related to the care of infants, at an accredited or approved college or university. This requirement is not met as evidenced by:
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Facility agrees to submit a written statement acknowledging S1 can not work alone in the infant classroom without the necessary units and what their plan will be to cover staff breaks. Facility agrees to submit written statement to CCL by 9/8/25.
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Based on interviews and record review, S1 was working in the infant classroom alone without the necessary units, which poses a potential health, safety and personal rights risk to children 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: Ana Noble
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5