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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414004945
Report Date: 09/06/2024
Date Signed: 09/06/2024 02:05:09 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/03/2024 and conducted by Evaluator Zeynep Basak
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20240903155438
FACILITY NAME:KIDS KONNECT INFANT CARE & PRESCHOOLFACILITY NUMBER:
414004945
ADMINISTRATOR:GROMOWSKI, COURTNEYFACILITY TYPE:
850
ADDRESS:137 NORTH SAN MATEO DRIVETELEPHONE:
(650) 452-2542
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY:20CENSUS: 15DATE:
09/06/2024
UNANNOUNCEDTIME BEGAN:
08:38 AM
MET WITH:Courtney GromowskiTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Staff pushed daycare child.
Staff did not report incident.
INVESTIGATION FINDINGS:
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On 9/6/2024 at 8:30 a.m., Licensing Program Analyst (LPA) Zeynep Basak conducted an unannounced visit to open the complaint received on 9/3/2024 and met with the director, Courtney Gromowski. The purpose of the inspection was explained, and LPA was granted entry. LPA observed 15 preschool children and 3 staff members, including the director, present during the complaint investigation today.

During the investigation, LPA obtained pertinent documents, including LIC 500 and LIC 9040, and verified the teacher's qualifications and Mandated reporter training. LPA also interviewed the director and two staff members during the visit. Based on the investigation and the information obtained, the above allegations are found to be substantiated, and the complaint to be closed.

Two Type B violation was issued today, in accordance with the California Code of Regulations, Title 22, Division 12 & Chapter 1 (a) (3) and (d) (C). The citations are being cited on the attached LIC 9099D.

An exit interview was conducted and a copy of this report and appeal rights were discussed and given to the director, Courtney Gromowski. Notice of Site Visit was provided to remain posted for 30 days.



Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024
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 2
Control Number 05-CC-20240903155438
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: KIDS KONNECT INFANT CARE & PRESCHOOL
FACILITY NUMBER: 414004945
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/06/2024
Section Cited
CCR
101223(a)(3)
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Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights: (3)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: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.
This requirement was not met as evidenced by:
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The staff was terminated.
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 Based on interviews and record review, staff pushed a daycare child. This poses a potential health and safety risk to children in care.
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Type B
09/06/2024
Section Cited
CCR
101212(d)(C)
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(d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Reporting Requirements (d)Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. (1)Events reported shall include the following: (C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child. This requirement was not met as evidenced by:
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Reporting Requirements were discussed with the director, who now acknowledged when, how, and where to report.
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 Based on interviews and record review, staff did not report incident.
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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: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2