Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334804329
Report Date: 05/04/2018
Date Signed 05/04/2018 05:36:01 PM


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/25/2018 and conducted by Evaluator Kim Leung
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20180425115941
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
334804329
ADMINISTRATOR:THERESA SALLEYFACILITY TYPE:
850
ADDRESS:11961 PERRIS BLVDTELEPHONE:
(951) 243-6558
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92557
CAPACITY:72CENSUS: 42DATE:
05/04/2018
UNANNOUNCEDTIME BEGAN:
07:25 AM
MET WITH:Theresa SalleyTIME COMPLETED:
05:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Emergency exits being blocked

Facility has roaches and nats

INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Kim Leung visited the facility to investigate the above allegations. Upon arrival, LPA met with facility director Theresa Salley and stated the purpose of the visit. It was alleged that emergency exits were blocked. It was further alleged that the facility has roaches and nats. During visit, LPA toured the facility conducting inspection. LPA did not observe any exit being blocked. LPA observed a cot stored next to the door leading to playground in the Discovery Preschool Room but that did not block the exit or present any risk to children's safety. During inspection, LPA observed no roaches, nats or any other insects in the facility. Interviews were conducted. LPA obtained information that sometimes there were nats outside of kitchen in the food and supplies receiving alley that is not part of the activity areas for children. The area is physically separated from the playground. LPA observed no nats or insects when inspection was conducted in the receiving alley. Conflicting information was received during interviews in regards to whether there were roaches or nats inside the facility.

(TO BE CONTINUED ON NEXT PAGE)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 784-4200
LICENSING EVALUATOR NAME: Kim LeungTELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2018
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 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/25/2018 and conducted by Evaluator Kim Leung
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20180425115941

FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
334804329
ADMINISTRATOR:THERESA SALLEYFACILITY TYPE:
850
ADDRESS:11961 PERRIS BLVDTELEPHONE:
(951) 243-6558
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92557
CAPACITY:72CENSUS: 42DATE:
05/04/2018
UNANNOUNCEDTIME BEGAN:
07:25 AM
MET WITH:Theresa SalleyTIME COMPLETED:
05:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Failure to comply with personnel record requirements

Failure to comply with children's record requirements

INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Kim Leung visited the facility to investigate the above allegations. Upon arrival, LPA met with facility director Theresa Salley and stated the purpose of the visit. It was alleged that some employees work in the classrooms without proper documentation. It was also alleged that children's files are not correct. During visit, LPA reviewed all teaching staff's records. Record review revealed that staff supervising children met the teacher qualification requirements. However, complete immunization records for two of the staff members and TB test result for one of the staff members were not available for review during inspection. A sample of 11 children's records were reviewed. TB test result for a child and updated immunization records for another child were not available for review. In addition, acknowledgement of receipt Licensing Report dated 4/24/2018 documented a Type A (serious) deficiency were not found. As stated by Ms. Salley, the report has not been provided to all of the enrolled families yet.
(TO BE CONTINUED ON NEXT PAGE)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 784-4200
LICENSING EVALUATOR NAME: Kim LeungTELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2018
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 8
Control Number 09-CC-20180425115941
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 334804329
VISIT DATE: 05/04/2018
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 upon the information gathered, the preponderance of evidence standard has been met. The allegations are therefore substantiated.

See LIC9099D for deficiencies cited per California Code of Regulations, Title 22, Division 12.

Exit interview was conducted with assistant director Gelitzly Vargas. Appeal rights were explained. A copy of this report was provided to the facility. A NOTICE OF SITE VISIT WAS ISSUED AND IS TO BE POSTED IN A PROMINENT LOCATION AT THE FACILITY FOR THE NEXT 30 DAYS.

A copy of this report must be made available to the public for 3 years.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 784-4200
LICENSING EVALUATOR NAME: Kim LeungTELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2018
LIC9099 (FAS) - (06/04)
Page: 3 of 8
Control Number 09-CC-20180425115941
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 334804329
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/04/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/18/2018
Section Cited
HSC
1596.7995
1
2
3
4
5
6
7
SB792 Employee Immunization Requirements. Complete immunization records for 2 of the teachers were not available for review during inspection.
1
2
3
4
5
6
7
Assistant director Gelitzly Vargas agreed to submit copy to the Department by 5/18/2018.
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
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.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 784-4200
LICENSING EVALUATOR NAME: Kim LeungTELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2018
LIC9099 (FAS) - (06/04)
Page: 5 of 8
Control Number 09-CC-20180425115941
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 334804329
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/04/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/11/2018
Section Cited
HSC
1596.8595c
1
2
3
4
5
6
7
AB633. Records revealed that Licensing Evaluation Report dated 4/24/2018 documenting Type A deficiency was not provided to all of the enrolled families. That took away the parents' rights to know the compliance history of the facility.
1
2
3
4
5
6
7
Assistant director Gelitzly Vargas agreed to provide copy of the reports to all enrolled families and submit copy and roster to the Department by 5/11/2018.
Type B
05/18/2018
Section Cited
CCR
101220(b)(2)
1
2
3
4
5
6
7
Child's Medical Assessments. A review of a sample of 11 children's records were conducted. TB test result for one of the children was not available for review during inspection.
1
2
3
4
5
6
7
Assistant director Gelitzly Vargas agreed to submit copy to the Department by 5/18/2018.
Type B
05/18/2018
Section Cited
CCR
101220.1(a)
1
2
3
4
5
6
7
Immunization. A review of a sample of 11 children's records were conducted. updated immunization records for one of the children were not available for review during inspection.
1
2
3
4
5
6
7
Assistant director Gelitzly Vargas agreed to submit copy to the Department by 5/18/2018.
Type B
05/18/2018
Section Cited
CCR
101216(g)(1)
1
2
3
4
5
6
7
Personnel Requirements. TB test result for a teacher was not available for review during inspection.
1
2
3
4
5
6
7
Assistant director Gelitzly Vargas agreed to submit copy to the Department by 5/18/2018.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 784-4200
LICENSING EVALUATOR NAME: Kim LeungTELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2018
LIC9099 (FAS) - (06/04)
Page: 4 of 8
Control Number 09-CC-20180425115941
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 334804329
VISIT DATE: 05/04/2018
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 upon the observations and the information gathered throughout the investigation process, there is not a preponderance of evidence to corroborate the allegations.

Based upon the information gathered, there is not a preponderance of evidence to support or dismiss the allegations. The above allegations are ruled unsubstantiated at this time.

Exit interview was conducted with assistant director Gelitzly Vargas. Notice of Site Visit was issued and must be posted for 30 day. A copy of this report was provided to the facility.

A copy of this report must be made available to the public for 3 years.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 784-4200
LICENSING EVALUATOR NAME: Kim LeungTELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2018
LIC9099 (FAS) - (06/04)
Page: 8 of 8