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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343622379
Report Date: 05/25/2022
Date Signed: 05/26/2022 03:04:03 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/24/2022 and conducted by Evaluator Gagandeep Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20220124105831
FACILITY NAME:KIDDY CLUBFACILITY NUMBER:
343622379
ADMINISTRATOR:REID, MARLETTFACILITY TYPE:
850
ADDRESS:7710 STOCKTON BLVDTELEPHONE:
(916) 617-7248
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY:58CENSUS: 38DATE:
05/25/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Marlett ReidTIME COMPLETED:
10:40 AM
ALLEGATION(S):
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Staff handled a child in rough manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Gagandeep Singh and Erwin Tjhia met with facility representative, Marlett Reid, to deliver the findings of the investigation for above allegation. Purpose of the inspection was explained.

Before the complaint was submitted, the facility also self reported an incident of staff being accused, to the Department. During the investigation, LPA interviewed random children from same classroom, all staff members present at the time of incident, director and obtain copy of police report and copy of the video recording from the classroom for the time of incident. It was observed on the video recording that a staff person roughly grabbed a child by the wrist and sat child down in a chair to put child’s shoes on, at one point child slumps over and staff roughly pulled child up from the shoulder. Child is observed crying off and on throughout the interaction and wiping their nose. In the police report, staff person admitted that they restrained the child due to behavior issues. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegations is found to be SUBSTANTIATED. California Code of Regulations, are being cited on the attached LIC 9099D. Copy of this report was reviewed and provided to the facility representative. Notice of site visit is posted and shall remain posted for next 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022
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 2
Control Number 03-CC-20220124105831
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: KIDDY CLUB
FACILITY NUMBER: 343622379
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/26/2022
Section Cited
CCR
101223(a)(3)
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Personal Rights: The licensee shall ensure that each child is accorded the following personal rights: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to:
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The director agreed to conduct the meeting with all staff about the supervision. One meeting was conducted and another will be conducted in June 2022.
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 interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning. This requirement is not met as evidenced by staff interview and video recording that a staff handled a child in rough manner. This poses an immediate health and safety 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: Maria Mayorga
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2