073401322-6-27-2025-02-CC-SJON-DJZV8E-20250728161233

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 073401322
Report Date: 06/27/2025
Date Signed: 06/27/2025 04:49:33 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/24/2025 and conducted by Evaluator Diana Campos

PUBLIC

COMPLAINT CONTROL NUMBER: 02-CC-20250424080428

FACILITY NAME:	KINDERCARE LEARNING CENTER, #1039		FACILITY NUMBER:	073401322
ADMINISTRATOR:	ACOSTA, SELENE		FACILITY TYPE:	850
ADDRESS:	2300 MAHOGANY WAY		TELEPHONE:	(925) 778-8888
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94509
CAPACITY:	95	CENSUS: 36	DATE:	06/27/2025
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Selene Acosta		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff handled day care child in a rough manner.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

LPAs J. Maiwandi and D. Campos met with Director Selene Acosta for a subsequent complaint investigation regarding the above allegation. Present for this investigation were 9 Staff and 36 preschool children in care. During the course of the investigation, interviews were conducted files and records reviewed. It was alleged that staff handled a day care child in a rough manner. Although interviews did not disclose any staff handling a day care child in a rough manner another party reported staff handled a child in a rough manner. Due to conflicting information given to the LPAs the allegation is deemed unsubstantiated at this time.

Exit interview conducted with Director Selene Acosta.
Notice of Site Visit was provided and must remain posted for 30 days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2025

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 13

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/24/2025 and conducted by Evaluator Diana Campos

COMPLAINT CONTROL NUMBER: 02-CC-20250424080428

FACILITY NAME:	KINDERCARE LEARNING CENTER, #1039		FACILITY NUMBER:	073401322
ADMINISTRATOR:	ACOSTA, SELENE		FACILITY TYPE:	850
ADDRESS:	2300 MAHOGANY WAY		TELEPHONE:	(925) 778-8888
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94509
CAPACITY:	95	CENSUS: 36	DATE:	06/27/2025
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Selene Acosta		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are operating out of ratio

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

LPAs J. Maiwandi and D. Campos met with Director Selene Acosta for a subsequent complaint investigation regarding the above allegation. Present for this investigation were 9 Staff and 36 preschool children in care. During the course of the investigation, interviews and observations were conducted. It was alleged that staff are operating out of ratio. At 10:35 AM LPA's observed 1 teacher and 1 teacher assistant supervising 16 preschool children which made the facility out of ratio. Director stated they were down 1 teacher for that classroom today. Based on the investigative findings the preponderance of evidence standard has been met. Therefore the allegation is deemed substantiated.

Exit interview conducted with Director Selene Acosta.
Notice of Site Visit was provided and must remain posted for 30 days.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 13

Control Number 02-CC-20250424080428

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: KINDERCARE LEARNING CENTER, #1039	FACILITY NUMBER: 073401322
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/27/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/11/2025 Section Cited CCR 101216.3(a)(b)	1 2 3 4 5 6 7	101216.3 Teacher-Child Ratio (a)There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below. (b)The licensee may use teacher aides in a teacher-child ratio of one teacher and one aide for every 15 children in attendance.	1 2 3 4 5 6 7	Director shall submit by the POC date a plan of action detailing how they will stay within ratio going forward.
	8 9 10 11 12 13 14	this requirement was not met as evidenced by: LPAs observed 1 teacher and 1 aid supervising 16 children which poses a potential health and safety risk to persons 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: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 13

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/24/2025 and conducted by Evaluator Diana Campos

COMPLAINT CONTROL NUMBER: 02-CC-20250424080428

FACILITY NAME:	KINDERCARE LEARNING CENTER, #1039		FACILITY NUMBER:	073401322
ADMINISTRATOR:	ACOSTA, SELENE		FACILITY TYPE:	850
ADDRESS:	2300 MAHOGANY WAY		TELEPHONE:	(925) 778-8888
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94509
CAPACITY:	95	CENSUS: 36	DATE:	06/27/2025
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Selene Acosta		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not ensure the bathrooms are clean

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

LPAs J. Maiwandi and D. Campos met with Director Selene Acosta for a subsequent complaint investigation regarding the above allegation. Present for this investigation were 9 Staff and 36 preschool children in care. During the course of the investigation, interviews and observations were conducted. It was alleged that staff do not ensure the bathrooms are clean. On 4/30/2025 at 1:45 PM LPA's observed toilets were used and not flushed containing waste and other debris. LPAs also observed a laundry basket, used toilet paper and other debris on the bathroom floor in at least one of the preschool classrooms. Based on the investigative findings the preponderance of evidence standard has been met. Therefore the allegation is deemed substantiated.

Exit interview conducted with Director Selene Acosta.
Notice of Site Visit was provided and must remain posted for 30 days.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 4 of 13

Control Number 02-CC-20250424080428

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: KINDERCARE LEARNING CENTER, #1039	FACILITY NUMBER: 073401322
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/27/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/11/2025 Section Cited CCR 101223(a)(2)	1 2 3 4 5 6 7	101223 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.	1 2 3 4 5 6 7	Today bathrooms were clean. Citation is cleared today during inspection.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: On 4/30/25 LPAs observed toilets were used and not flushed containing waste and other debris, a laundry basket, used toilet paper and other debris on the bathroom floor of the preschool classrooms. Which poses a potential health and safety risk to 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: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2025

LIC9099 (FAS) - (06/04)

Page: 5 of 13

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/24/2025 and conducted by Evaluator Diana Campos

COMPLAINT CONTROL NUMBER: 02-CC-20250424080428

FACILITY NAME:	KINDERCARE LEARNING CENTER, #1039		FACILITY NUMBER:	073401322
ADMINISTRATOR:	ACOSTA, SELENE		FACILITY TYPE:	850
ADDRESS:	2300 MAHOGANY WAY		TELEPHONE:	(925) 778-8888
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94509
CAPACITY:	95	CENSUS: 36	DATE:	06/27/2025
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Selene Acosta		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not ensure the classroom has hygiene supplies

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

LPAs J. Maiwandi and D. Campos met with Director Selene Acosta for a subsequent complaint investigation regarding the above allegation. Present for this investigation were 9 Staff and 36 preschool children in care. During the course of the investigation, interviews and observations were conducted. It was alleged that staff do not ensure the classroom has hygiene supplies. On 4/30/2025 at 1:45 PM LPA's observed there was no soap or paper towels available within children's reach in at least 2 of the preschool classrooms. Based on the investigative findings the preponderance of evidence standard has been met. Therefore the allegation was deemed substantiated.

Exit interview conducted with Director Selene Acosta.
Notice of Site Visit was provided and must remain posted for 30 days.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 6 of 13

Control Number 02-CC-20250424080428

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: KINDERCARE LEARNING CENTER, #1039	FACILITY NUMBER: 073401322
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/27/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/11/2025 Section Cited CCR 101223(a)(2)	1 2 3 4 5 6 7	101223 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.	1 2 3 4 5 6 7	Today LPAs observed soap and paper towels dispenser were stocked and available to children in care. Citation is cleared today during inspection.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: On 4/30/25 LPAs observed no soap or paper towels available within children's reach in at least 2 of the preschool classrooms which poses a potential health and safety risk to 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: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2025

LIC9099 (FAS) - (06/04)

Page: 7 of 13

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/24/2025 and conducted by Evaluator Diana Campos

COMPLAINT CONTROL NUMBER: 02-CC-20250424080428

FACILITY NAME:	KINDERCARE LEARNING CENTER, #1039		FACILITY NUMBER:	073401322
ADMINISTRATOR:	ACOSTA, SELENE		FACILITY TYPE:	850
ADDRESS:	2300 MAHOGANY WAY		TELEPHONE:	(925) 778-8888
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94509
CAPACITY:	95	CENSUS: 36	DATE:	06/27/2025
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Selene Acosta		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Children's restroom is not in good repair

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

LPAs J. Maiwandi and D. Campos met with Director Selene Acosta for a subsequent complaint investigation regarding the above allegation. Present for this investigation were 9 Staff and 36 preschool children in care. During the course of the investigation, interviews and observations were conducted. It was alleged that children's restroom is not in good repair. On 4/30/2025 at 1:45 PM LPA's observed 2 of 3 toilets in the preschool classroom were out of order clogged by waste and other debris, and 2 of the sinks inside the bathroom had no running water. Toilets were covered in a large plastic bag to avoid being used. Director stated they were not aware of the issue and would place a work order to resolve. Based on the investigative findings the preponderance of evidence standard has been met. Therefore the allegation was deemed substantiated.

Exit interview conducted with Director Selene Acosta.
Notice of Site Visit was provided and must remain posted for 30 days.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 8 of 13

Control Number 02-CC-20250424080428

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: KINDERCARE LEARNING CENTER, #1039	FACILITY NUMBER: 073401322
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/27/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/11/2025 Section Cited CCR 101238(a)	1 2 3 4 5 6 7	101238 Buildings and Grounds (a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.	1 2 3 4 5 6 7	LPAs observed toilets are operable today. Citation is cleared during today's inspection.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: 4/30/2025 at 1:45 PM LPA's observed 2 of 3 toilets in the preschool classroom were out of order clogged by waste and other debris, and 2 of the sinks inside the bathroom had no running water which poses a potential health and safety risk to 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: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2025

LIC9099 (FAS) - (06/04)

Page: 9 of 13

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/24/2025 and conducted by Evaluator Diana Campos

COMPLAINT CONTROL NUMBER: 02-CC-20250424080428

FACILITY NAME:	KINDERCARE LEARNING CENTER, #1039		FACILITY NUMBER:	073401322
ADMINISTRATOR:	ACOSTA, SELENE		FACILITY TYPE:	850
ADDRESS:	2300 MAHOGANY WAY		TELEPHONE:	(925) 778-8888
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94509
CAPACITY:	95	CENSUS: 36	DATE:	06/27/2025
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Selene Acosta		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Day care child sustained unexplained injury while in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 10 of 13

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/24/2025 and conducted by Evaluator Diana Campos

COMPLAINT CONTROL NUMBER: 02-CC-20250424080428

FACILITY NAME:	KINDERCARE LEARNING CENTER, #1039		FACILITY NUMBER:	073401322
ADMINISTRATOR:	ACOSTA, SELENE		FACILITY TYPE:	850
ADDRESS:	2300 MAHOGANY WAY		TELEPHONE:	(925) 778-8888
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94509
CAPACITY:	95	CENSUS: 36	DATE:	06/27/2025
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Selene Acosta		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility does not meet child's toileting needs

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 11 of 13