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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364846188
Report Date: 04/26/2022
Date Signed: 04/26/2022 10:18:36 AM

Substantiated


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
04/22/2022 and conducted by Evaluator Patricia Berry
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20220422091542
FACILITY NAME:KIDDIE ACADEMY OF RANCHO CUCAMONGAFACILITY NUMBER:
364846188
ADMINISTRATOR:HEATHER JENKINSFACILITY TYPE:
850
ADDRESS:7220 VICTORIA PARK LANETELEPHONE:
(909) 891-8700
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91739
CAPACITY:127CENSUS: 73DATE:
04/26/2022
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Beth Holmes/LicenseeTIME COMPLETED:
10:42 AM
ALLEGATION(S):
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Child was left outside without supervision.
INVESTIGATION FINDINGS:
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On 4/26/22 at 9:15 am, Licensing Program Analyst (LPA) Patricia Berry conducted a complaint investigation. LPA was granted access into the facility and met with Beth Holmes. LPA toured facility and took a census.

It was self-reported on 4/21/22, a child was left on the playground, unattended. Director stated a staff member did not follow the correct procedures during transition time and the child was left on the playground for approximately 10 minutes.
Based on information director self-reporting the incident, the preponderance of evidence standard has been met; therefore, the above allegation Child was left outside without supervision is substantiated.

See 9099D for deficiency. LIC 421IM civil penalty has been assessed for $500.00.

(Cont on 9099C)
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022
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 3
Control Number 09-CC-20220422091542
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: KIDDIE ACADEMY OF RANCHO CUCAMONGA
FACILITY NUMBER: 364846188
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/27/2022
Section Cited
CCR
101229(a)(1)
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101229 (a) The licensee shall provide care and supervision...(1) No child(ren) shall be left without the supervision, ... Supervision shall include visual observation.
This requirement was not met as evidenced by
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Director immediately took child back to the classroom 4/21/22. Licensee stated she will conduct a training for all staff on CCR 101229 (a) (1), including “Name to Face” procedures and will send a list of participants to Community Care Licensing by 4/27/22.
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Based on director self-reporting the incident, a child was left unattended on the playground.
This is an immediate risk to the health and safety of children in care. Civil penalty LIC421IM assessed today of $500.00.
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Licensee created a log that each administrator will sign off on the log stating that all children are counted for.
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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: Patricia Berry
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 09-CC-20220422091542
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: KIDDIE ACADEMY OF RANCHO CUCAMONGA
FACILITY NUMBER: 364846188
VISIT DATE: 04/26/2022
NARRATIVE
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An exit interview was conducted, and a copy of this report was provided to licensee on this date. LPA provided a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224), Appeal Rights and the Notice of Site (LIC 9213) form to licensee. LPA verified the LIC 9213 form and a copy of this report was posted.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3