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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073407464
Report Date: 11/01/2021
Date Signed: 11/01/2021 12:48:56 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, 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
07/16/2021 and conducted by Evaluator Tasha Hackett-Alexander
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20210716153508
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
073407464
ADMINISTRATOR:ADEEBA AQMALFACILITY TYPE:
830
ADDRESS:4108 LONE TREE WAYTELEPHONE:
(925) 754-1236
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:30CENSUS: 1DATE:
11/01/2021
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:SHANNON REGACHOTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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PERSONAL RIGHTS- Child sustained injury while in care.

PERSONAL RIGHTS- Staff handled daycare child in a rough manner.
INVESTIGATION FINDINGS:
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LICENSING PROGRAM ANALYST TASHA ALEXANDER MET WITH CENTER DIRECTOR SHANNON REGACHO TO DELIVER THE FINDINGS TO THE ABOVE COMPLAINT ALLEGATIONS.

UPON ARRIVAL THERE IS 1 CHILD PERSENT IN THE INFANT CLASSROOM ALONG WITH 1 STAFF MEMBER. DURING THIS ANALYST 'S LAST VISIT, AN INTERVIEW WAS CONDUCTED WITH THE CENTER'S DIRECTOR AND SEVERAL DOCUMENTS WERE REQUESTED AND SUBMITTED. FURTHER INVESTIGATIONS WAS CONDUCTED.

BASED ON LPAs OBSERVATIONS AND INTERVIEWS WHICH WERE CONDUCTED AND RECORD REVIEWS, THE PREPONDERANCE OF EVIDENCE STANDARD HAS BEEN MET, THEREFORE THE ABOVE ALLEGATIONS ARE FOUND TO BE SUBSTANTIATED. CALIFORNIA CODE OF REGULATIONS, (Title 22, Division 12 & Chapter number 1), ARE BEING CITED ON THE ATTACHED LIC 9099D.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021
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 2
Control Number 02-CC-20210716153508
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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 073407464
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/05/2021
Section Cited
CCR
101`223(a)(2)
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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. REQUIREMENT HAS NOT BEEN MET:
CHILD SUSTAINED INJURY WHILE IN CARE.
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THE INCIDENT OCCURRED OVER 1 YEAR AGO. THE FACILITY TOOK MEASURES TO PREVENT THE CHILD FROM INJURING THEMSELF BY PUTTING SOFT BORDERS ON THE CHILD'S HIGHCHAIR. IT IS NOTED THAT THE CHILD NO LONGER ATTENDS THE FACILITY.
Type B
11/05/2021
Section Cited
CCR
101223(a)(3)
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101223 Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights:
(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning. REQUIREMENT HAS NOT BEEN MET:
Staff handled daycare child in a rough manner.
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THE INCIDENT OCCURRED 11 MONTHS AGO. THE FACILITY TOOK ACTION BY REPREMANDING THE STAFF MEMBER. SINCE THEN THE STAFF MEMBER IS NO LONGER AN EMPLOYEE OF THE FACILITY.
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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: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2