<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376300501
Report Date: 03/12/2024
Date Signed: 03/12/2024 02:40:54 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/21/2024 and conducted by Evaluator Keely Messerschmidt
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20240221124624
FACILITY NAME:KLOOSTERMAN FAMILY CHILD CAREFACILITY NUMBER:
376300501
ADMINISTRATOR:KLOOSTERMAN, JENNIFERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 822-1453
CITY:OCEANSIDESTATE: CAZIP CODE:
92054
CAPACITY:14CENSUS: 2DATE:
03/12/2024
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Jennifer KloostermanTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee temporary absence exceeded 20 percent of the hours at the facility
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On the above date and time Licensing Program Analyst (LPA) Keely Messerschmidt arrived at the facility for the purpose of delivering the complaint findings on the above-referenced allegations. LPA met with Licensee Jennifer Kloosterman. LPA toured the facility, conducted census, and verified facility staff and children enrollment. LPA discussed with Licensee the conclusion of the complaint investigation. The investigation included interviews with the Licensee and parents.

On February 23rd, 2024, Community Care Licensing (CCL) received a complaint alleging that Licensee temporary absence exceeded 20 percent of the hours at the facility. Based on information obtained, LPA Messerschmidt was able to corroborate above mentioned allegation.

See LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Keely Messerschmidt
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024
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 5
Control Number 10-CC-20240221124624
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: KLOOSTERMAN FAMILY CHILD CARE
FACILITY NUMBER: 376300501
VISIT DATE: 03/12/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
When it comes to the allegation that Licensee temporary absence exceeded 20 percent of the hours at the facility, based on interview with Licensee it was disclosed that there were two days in the month of January where the Licensee was not present, however, Licensee notified parents of her absence and kept communication through text and identified an assistant in her absence. Per parent interview, Licensee had informed parents of her absence, identified an assistant, and kept communication.

Based on LPA observations, interviews conducted and a review of records, the preponderance of evidence standard has been met. Therefore, the above allegation(s) is/are found to be SUBSTANTIATED.

An exit interview was conducted, and this report was reviewed with the Licensee, Jennifer Kloosterman, and a copy was provided. Appeal rights were discussed and provided during the exit interview. A Notice of Site visit was given, and Licensee understands that it must remain posted for 30 days.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Keely Messerschmidt
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 10-CC-20240221124624
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: KLOOSTERMAN FAMILY CHILD CARE
FACILITY NUMBER: 376300501
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/15/2024
Section Cited
CCR
102417(a)
1
2
3
4
5
6
7
Operation of a Family Child Care Home:
(a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise
1
2
3
4
5
6
7
Licensee will review regulation and create a plan on how absences will not exceed 20 percent of the hours that her facility provides care per day. Licensee will submit plan to LPA via email by 3/15/24.
8
9
10
11
12
13
14
children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day. This requirement was not met based on, Licensee admitted to being absent on 2 days during the month of January. This poses a potential health and safety risk to the children in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Deborah Mullen
LICENSING EVALUATOR NAME: Keely Messerschmidt
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/21/2024 and conducted by Evaluator Keely Messerschmidt
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20240221124624

FACILITY NAME:KLOOSTERMAN FAMILY CHILD CAREFACILITY NUMBER:
376300501
ADMINISTRATOR:KLOOSTERMAN, JENNIFERFACILITY TYPE:
810
ADDRESS:2413 PAPYRUS CT.TELEPHONE:
(760) 822-1453
CITY:OCEANSIDESTATE: CAZIP CODE:
92054
CAPACITY:14CENSUS: DATE:
03/12/2024
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Jennifer KloostermanTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
uncleared adult on the premises
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On the above date and time Licensing Program Analyst (LPA) Keely Messerschmidt arrived at the facility for the purpose of delivering the complaint findings on the above-referenced allegation. LPA met with Licensee Jennifer Kloosterman. LPA toured the facility, conducted census, and verified facility staff and children enrollment. LPA discussed with Licensee the conclusion of the complaint investigation. The investigation included interviews with the Licensee and parents.

On February 23rd, 2024, Community Care Licensing (CCL) received a complaint alleging that an uncleared adult on the premises. Based on interviews, LPA Messerschmidt is unable to corroborate above mentioned allegations.

See LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Keely Messerschmidt
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 10-CC-20240221124624
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: KLOOSTERMAN FAMILY CHILD CARE
FACILITY NUMBER: 376300501
VISIT DATE: 03/12/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Based on record review, observation and interview with Licensee for allegation of an uncleared adult on the premises, it was disclosed that there was an attempt to hire an assistant, but paperwork wasn't submitted, and file was closed.

Based on the information obtained during this investigation, it has been determined that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur. Therefore, the allegations are UNSUBSTANTIATED.

An exit interview was conducted, and this report was reviewed with the Licensee, Jennifer Kloosterman, and a copy was provided. Appeal rights were discussed and provided during the exit interview. A Notice of Site visit was given, and Licensee understands that it must remain posted for 30 days.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Keely Messerschmidt
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5