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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 503810107
Report Date: 12/13/2021
Date Signed: 12/13/2021 12:30:03 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/04/2021 and conducted by Evaluator Luisa Gavoutian
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20211004131236
FACILITY NAME:KIDS' COMMUNITY CAMPUSFACILITY NUMBER:
503810107
ADMINISTRATOR:MENDOZA, EUNICE GFACILITY TYPE:
850
ADDRESS:2490 N WALNUT RDTELEPHONE:
(209) 620-8389
CITY:TURLOCKSTATE: CAZIP CODE:
95382
CAPACITY:64CENSUS: 26DATE:
12/13/2021
ANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee/Director Eunice MendozaTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff continued to care for children while ill.
INVESTIGATION FINDINGS:
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On 12/13/2021, Licensing Program Analyst (LPA) Luisa Gavoutian conducted a scheduled televisit via Zoom with Licensee Eunice Mendoza to provide findings for the above-mentioned allegation. LPA discussed the allegation and a census was taken. During the course of the investigation, LPA interviewed witnesses and staff, reviewed facility records, and medical records.

Staff 1 stated to LPA that Staff 1 had been exposed to COVID-19 on 09/13/2021. A review of Staff 1’s medical records indicated that Staff 1 was tested for COVID-19 on Saturday, 09/18/2021, and received positive results on 09/22/2021. Staff 1 took another rapid at-home COVID-19 test on 09/23/2021 and received negative results.
(Continued on LIC 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Luisa Gavoutian
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2021
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 7
Control Number 04-CC-20211004131236
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: KIDS' COMMUNITY CAMPUS
FACILITY NUMBER: 503810107
VISIT DATE: 12/13/2021
NARRATIVE
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On 09/21/2021, LPA had spoken to Staff 1 by phone to follow-up on the facility’s COVID-19 positive cases. On that date, Staff 1 stated to LPA that Staff 1 had started developing symptoms of COVID-19 “last week” and was last at the facility on 09/16/2021. Staff 1 had stated that Staff 1 was quarantining at home and would be allowed to return to work on 09/25/2021, per Stanislaus County Public Health Department.

On 10/07/2021, LPA and Staff 1 watched security video footage from the facility, which revealed that Staff 1 had transported children to and from school on 09/15/2021 – 09/17/2021, and had transported children to school on 09/20/2021. This footage revealed that Staff 1 had been present at the facility on 09/17/2021, despite having previously stated that Staff 1’s last day at the facility was 09/16/2021. Furthermore, footage revealed that Staff 1 transported children to school on 09/20/2021, while pending COVID-19 test results. Staff 1 stated that Staff 1 only transported children on those days and did not provide care inside the classrooms. LPA explained to Staff 1 that transporting children is also providing care and children can still be exposed to communicable diseases in a vehicle. Staff 1 had also informed LPA that Staff 1 began developing COVID-19 symptoms on the night of 09/17/2021.

LPA emailed Licensee with a copy of PIN 21-18-CCP, released on 06/29/2021, which provides the link to the “Guidance for Child Care Providers and Programs.” This guidance explains that the Cal/OSHA COVID-19 Prevention Program (CPP) written plan is required under the Cal/OSHA COVID-19 Emergency Temporary Standards. Details and a template for the plan can be accessed through the California Department of Industrial Relation's COVID-19 Prevention Emergency Temporary Standards webpage. Furthermore, the guidance explains that each facility should have a written plan for when a child or staff member has been exposed to someone with COVID-19, has symptoms of COVID-19 or tests positive for COVID-19. Licensee shall submit this plan, along with the CPP written plan to Community Care Licensing (CCL) by 01/13/2022.

Based upon observations, and information gathered through interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated.
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Luisa Gavoutian
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 04-CC-20211004131236
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: KIDS' COMMUNITY CAMPUS
FACILITY NUMBER: 503810107
VISIT DATE: 12/13/2021
NARRATIVE
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“Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months." The licensee was provided a copy of the "Fact Sheet" for AB 633 (Parent Notification Requirements), along with a copy of the relevant documents this date. A completed signed copy of the LIC 9224 will be placed in each child's file.

Per California Code of Regulations, Title 22, Division 12, Chapter 1, these deficiencies are being cited on the attached LIC 9099-D. An exit interview conducted with Licensee Eunice Mendoza.
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Luisa Gavoutian
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 04-CC-20211004131236
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: KIDS' COMMUNITY CAMPUS
FACILITY NUMBER: 503810107
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/13/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/14/2021
Section Cited
CCR
101223(a)(2)
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Personal Rights; (a) The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by:
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Universal health screenings, including for self, staff, children, and visitors, will be implemented immediately and a written statement confirming implementation shall be submitted to CCL by 12/14/2021. Additionally, the facility’s CPP plan and the facility’s written plan for when a child or staff member has been exposed to,
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Based on interview and records reviewed, Licensee failed to provide safe and healthful accommodations as described in LIC 9099. This posed an immediate threat to the health, safety, or personal rights of children.
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has symptoms of, or tests positive for COVID-19 shall be submitted to CCL by 01/13/2022.
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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: Alice Juarez
LICENSING EVALUATOR NAME: Luisa Gavoutian
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 04-CC-20211004131236
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: KIDS' COMMUNITY CAMPUS
FACILITY NUMBER: 503810107
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/13/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/13/2022
Section Cited
HSC
1596.885
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Conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of this state. This requirement was not met as evidenced by:
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Licensee stated that a written statement will be submitted addressing this deficiency.
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Based on interview and record review, Staff 1 provided false statements to LPA related to the date of last presence at the facility as described in LIC 9099. This poses a potential threat to the health, safety, or personal rights of children.
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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: Alice Juarez
LICENSING EVALUATOR NAME: Luisa Gavoutian
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2021
LIC9099 (FAS) - (06/04)
Page: 7 of 7