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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334846161
Report Date: 07/08/2024
Date Signed: 07/08/2024 03:26:27 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
04/15/2024 and conducted by Evaluator Claudia Caywood
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20240415132042
FACILITY NAME:KIDDIE ACADEMY OF CORONAFACILITY NUMBER:
334846161
ADMINISTRATOR:MELISSA BORBOAFACILITY TYPE:
850
ADDRESS:3977 BEDFORD CANYON RDTELEPHONE:
(951) 444-7434
CITY:CORONASTATE: CAZIP CODE:
92883
CAPACITY:108CENSUS: 91DATE:
07/08/2024
UNANNOUNCEDTIME BEGAN:
02:29 PM
MET WITH:Melissa Borboa, DirectorTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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1) Responsibility for Providing Care and Supervision- Child sustained unexplained injuries while in care
2) Personal Rights-Staff do not ensure adequate care and supervision is provided to children in care
INVESTIGATION FINDINGS:
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On 7/8/2024, at 2:10 PM, Licensing Program Analyst (LPA) Claudia Caywood conducted an unannounced visit to the facility for the purpose of concluding a complaint investigation. LPA met with Director, Melissa Borboa regarding the above listed allegations, which was received by the department on 4/15/2024. During the visit, LPA toured the facility, took census, and spoke to the Director regarding final findings.

Allegations: 1) Staff did not ensure care and supervision is provided to children in care. 2) Child sustained unexplained injuries while in care.

During the investigation, LPA conducted interviews with all pertinent parties, including staff, reviewed children and staff files, and toured the facility.

Cont. 809-C

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Claudia Caywood
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2024
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 09-CC-20240415132042
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: KIDDIE ACADEMY OF CORONA
FACILITY NUMBER: 334846161
VISIT DATE: 07/08/2024
NARRATIVE
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It was alleged staff do not ensure care and supervision is provided to children in care and a child sustained unexplained injuries while in care. A child was observed with scratch marks and staff could not explain how the child sustained the scratches.

It was determined the child sustained the scratches while in care at the facility. It was confirmed staff wrote an incident report disclosing the child sustained scratches but was unable to provide details of how the child sustained the scratches as no staff witnessed how the child was scratched.

Based on LPAs interviews conducted, and documentation reviewed, the facility staff did not comply with the Title 22 regulation of The General Requirements and Definitions Title 22 regulation code 101229 (a)(1) The preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 12) are cited on the attached LIC9099D.

LPA informed the facility representative, Melissa Borboa, all Type A citations shall be reported to parents/guardians of all children currently enrolled by the next business day, or the next day children are in care, and to parents/guardians of newly enrolled children for 12 months from the date of the citation. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.


Appeal rights issued and discussed with Melissa Borboa and their signature on this form acknowledges receipt of these rights. An exit interview was conducted, and a copy of this report was provided to the Director, Melissa Borboa.

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

THIS REPORT MUST BE AVAILABLE TO THE PUBLIC FOR THREE YEARS.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Claudia Caywood
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 09-CC-20240415132042
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: KIDDIE ACADEMY OF CORONA
FACILITY NUMBER: 334846161
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/09/2024
Section Cited
CCR
101229(a)(1)
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101229: Responsibility for Providing Care and Supervision. (a)The licensee ... care and supervision as 1) No child(ren)... left without the supervision of a teacher at any time... Supervision shall linclude visual observation. This requirement was not met as evidenced by:


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Director stated they would be reviewing the Title 22 regulation that was violated with all preschool staff members and have each staff member sign a letter of acknowledgement stating they understand the regulation.
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Based on LPAs interviews and records review no staff member could explain how the subject child sustained scratch marks while 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: Claudia Caywood
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3