Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334804331
Report Date: 05/04/2018
Date Signed 05/04/2018 05:37:16 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-20180425124455

FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
334804331
ADMINISTRATOR:THERESA SALLEYFACILITY TYPE:
830
ADDRESS:11961 PERRIS BLVDTELEPHONE:
(951) 243-6558
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92557
CAPACITY:24CENSUS: 8DATE:
05/04/2018
UNANNOUNCEDTIME BEGAN:
07:25 AM
MET WITH:Theresa SalleyTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Facility failed to report incidents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kim Leung visited the facility to investigate the above allegation. Upon arrival, LPA met with facility director Theresa Salley and stated the purpose of the visit. It was alleged that facility failed to report incidents. During visit, LPA reviewed records of all of the children enrolled in the facility currently. Interviews were conducted. LPA observed multiple incident reports filed in children's records documenting incidents and injuries. Each of the incident reports found in children's files was dated and LPA observed signatures in the employee signature box and parent/guardian signature box. LPA obtained information that it is the facility policy that staff are required to document incidents and injuries and provide a written report to the children's parents or guardians. Based upon the information gathered throughout the investigation process, there is not a preponderance of evidence to corroborate the allegation.

(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: 3 of 4
Control Number 09-CC-20180425124455
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: 334804331
VISIT DATE: 05/04/2018
NARRATIVE
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Based upon the information gathered, there is not a preponderance of evidence to support or dismiss the allegation. The above allegation is 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: 4 of 4