Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364812754
Report Date: 10/27/2017
Date Signed: 11/01/2017 02:48:03 PM


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
10/24/2017 and conducted by Evaluator Patricia Berry
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20171024142225
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
364812754
ADMINISTRATOR:JACLEEN RUCKERFACILITY TYPE:
850
ADDRESS:11249 BASELINE AVENUETELEPHONE:
(909) 581-0944
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY:90CENSUS: 59DATE:
10/27/2017
UNANNOUNCEDTIME BEGAN:
02:49 PM
MET WITH:Ashley Rawls/Assistant Director TIME COMPLETED:
04:50 PM
ALLEGATION(S):
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Facility staff failed to notify children's authorized representatives of an outbreak
INVESTIGATION FINDINGS:
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Licensing program analyst (LPA) Patricia Berry conducted an unannounced complaint visit in regards to the above allegations "Facility staff failed to notify children's authorized representatives of an outbreak". LPA toured facility and took census.

Assistant director Ashley Rawsl stated she was notified by two parents who reported their child was diagnosed with conjunctivitis (pink eye); first diagnosis reported to facility on 10/25 and the second diagnosis reported on 10/26. Assistant director stated she did not notify parents. Assistant director stated they notify parents by putting up notices on each classroom door. LPA observed there were no notices of the recent conjunctivitis (pink eye) posted on each classroom door.

(Cont on 9099C)





Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lya JohnsonTELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Patricia BerryTELEPHONE: (951) 233-3964
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2017
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 4
Control Number 09-CC-20171024142225
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: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 364812754
VISIT DATE: 10/27/2017
NARRATIVE
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Based on LPA’s own observation that no signs were posted on each classroom door and Assistant director stating she failed to notify parents of recent conjunctivitis (pink eye) diagnoses the preponderance of evidence standard has been met, therefore the above allegation/s is found to be SUNSTANTIATED. California Code of Regulations, (Title 22, divisions & chapter number) are being cited on the attached LIC 9099D.”)

Exit interview was conducted with assistant director Ashley Rawls.

Appeal rights and report given.

Notice of Site Visit was issued.

SUPERVISOR'S NAME: Lya JohnsonTELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Patricia BerryTELEPHONE: (951) 233-3964
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2017
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 09-CC-20171024142225
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: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 364812754
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/27/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
11/02/2017
Section Cited
CCR
101212(f)(1)(E)
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Reporting Requirements
(f) The items specified in (d)(1)(A) through (H) above shall also be reported to the child's authorized representative. (1) Events reported shall include the following:
(E) Epidemic outbreaks.
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Assistant director put a notification on each classroom door notifying parents of conjunctivitis (pink eye). Assistant director stated she will send a written statement of acknowledgement, understanding and compliance to regulation 101212 (f) and send written statment to CCL by 11/2/17.
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Assistant director stated she failed to notify parents that there was a recent outbreak of conjuntivitis (pink eye).

"This poses a potential risk to the Health and Safety of 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.
SUPERVISOR'S NAME: Lya JohnsonTELEPHONE: (951) 782-4216
LICENSING EVALUATOR NAME: Patricia BerryTELEPHONE: (951) 233-3964
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2017
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2017
LIC9099 (FAS) - (06/04)
Page: 2 of 4