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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 444408785
Report Date: 11/21/2023
Date Signed: 11/21/2023 11:05:20 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/14/2023 and conducted by Evaluator Cortney Nelson
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20231114134704
FACILITY NAME:CKC CHILDREN'S CENTERFACILITY NUMBER:
444408785
ADMINISTRATOR:TINA BURCHERFACILITY TYPE:
850
ADDRESS:8005 WINKLE AVENUETELEPHONE:
(831) 475-6587
CITY:SANTA CRUZSTATE: CAZIP CODE:
95065
CAPACITY:42CENSUS: 22DATE:
11/21/2023
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Tina Burcher & Kylie RobertsTIME COMPLETED:
11:23 AM
ALLEGATION(S):
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Absence of Supervision
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Cortney Nelson, met with Site Director, Tina Burcher, and Executive Director, Kylie Roberts, and explained purpose of visit, to open complaint investigation. Upon arrival, LPA was admitted into the facility by a staff member.

LPA conducted interviews with the Site Director, Executive Director, and staff member regarding a child who's location was unknown during pick-up on 11/14/2023. The Site Director and staff member, who were present on the day of the incident, reported that the child left the classroom during pick-up time, most likely due to the classroom door being proped open. The child was located outside in the play yard after approximately one minute. Based on interviews conducted, the preponderance of evidence standard has been met, and therefore the above allegation is SUBSTANTIATED.

California Code of Regulations (Title 22, Division 12) are being cited on attached LIC9099-D.

***Report continued on LIC9099-C***
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2023
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 07-CC-20231114134704
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CKC CHILDREN'S CENTER
FACILITY NUMBER: 444408785
VISIT DATE: 11/21/2023
NARRATIVE
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LPA informed Executive Director, Kylie Roberts, that this report dated (11/21/2023) documents one Type A citation, which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA informed the Executive Director to provide a copy of this licensing report dated (11/21/2023) that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

As a result of today's inspection, deficiencies have been cited, see LIC9099-D.

Exit interview conducted and report was reviewed with Executive Director, Kylie Roberts.

A NOTICE OF SITE VISIT HAS BEEN GIVEN AND MUST BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 07-CC-20231114134704
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CKC CHILDREN'S CENTER
FACILITY NUMBER: 444408785
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
11/22/2023
Section Cited
CCR
101229(a)(1)
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101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time...Supervision shall include visual observation.

This requirement was not met as evidenced by:
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The Site Director has relocated the sign-in/out for the center, so parents come into the classroom and do not prop the door open. She further states that parents have been reminded to keep the classroom door closed.
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The Licensee did not ensure that children are supervised at all times. During pick-up time, a child's whereabouts were unknown and the child was located outside of the facility, which poses an immediate risk to the health, safety, and personal rights 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.
SUPERVISORS NAME: Jennifer Pare
LICENSING EVALUATOR NAME: Joel Segura
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5