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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013412610
Report Date: 07/19/2024
Date Signed: 07/19/2024 11:07:11 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/10/2024 and conducted by Evaluator Morgan Pringle
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20240510152235
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
013412610
ADMINISTRATOR:JAMIE CZELUSNIAKFACILITY TYPE:
830
ADDRESS:4655 LASSEN ROADTELEPHONE:
(925) 455-1560
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY:36CENSUS: 33DATE:
07/19/2024
ANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jamie CzelusniakTIME COMPLETED:
10:49 AM
ALLEGATION(S):
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Staff do not provide adequate supervision resulting in a child being injured in care.
INVESTIGATION FINDINGS:
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On 7/19/2024 at 9:00am Licensing Program Analyst (LPA) Morgan Pringle met with Director Jaime Czelusniak and Assistant Director for a complaint that was filed against the facility alleging staff do not provide adequate supervision resulting in a child being injured in care. Facility is dual licensed and holds a license for preschool (013412608) as well. Present during the visit are twenty-one (21) infants and six (6) additional staff members.

Through the complaint investigation, interviews were conducted, and documents were collected. It was found that a child was in injured at the facility due to a lack of supervision. LPA determined the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22 is being cited on the attached LIC 9099D.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with Director Jamie Czelusniak.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 52-CC-20240510152235
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 013412610
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/19/2024
Section Cited
CCR
101429(a)(1)
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101429(a) In addition to Section 101229, the following shall apply: (1) Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times.

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Facility provided a POC for supervision on 7/11/2024. Facility stated how they will ensure supervision is conducted at all times to prevent children’s incidents. POC has been fulfilled.
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This requirement was not met as evidenced by: A child sustained an injury in care due to lack of supervision which poses a potential risk to the health and safety of the 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: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2