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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198003097
Report Date: 11/18/2021
Date Signed: 11/18/2021 01:35:18 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/21/2021 and conducted by Evaluator Thelma Razo
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20211021161351
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
198003097
ADMINISTRATOR:MARGIE ZARATEFACILITY TYPE:
850
ADDRESS:3443 S. NOGALES STREETTELEPHONE:
(626) 965-9611
CITY:WEST COVINASTATE: CAZIP CODE:
91792
CAPACITY:60CENSUS: 44DATE:
11/18/2021
UNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Margie Zarate, DirectorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Facility does not maintain first aid supplies for children in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Thelma Razo conducted a subsequent complaint inspection to deliver findings on the allegation of" Facility does not maintain first aid supplies for children in care".
During this investigation, interviews were conducted with 4 staff, 7 parents and 4 children.
Staff and children interviewed did not disclose that the facility run out of first aid supplies. Parents interviewed did not disclose any concerns with the staff or facility. On 10/28/2021, LPA toured the facility to include three classrooms and observed first aid supplies in each classroom. Included were supplies as mandated under Title 22 Division 12 Chapter 1 such as first-aid manual, sterile first-aid dressings, bandages, adhesive tape, wipes with alcohol, scissors, tweezers and thermometer. The facility has ice pack and gloves as well. Today, LPA did another facility tour and observed all the required first aid supplies were available.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore at this time the above allegation is unsubstantiated.

Exit interview conducted and report was reviewed with Director Margie Zarate.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/21/2021 and conducted by Evaluator Thelma Razo
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20211021161351

FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
198003097
ADMINISTRATOR:MARGIE ZARATEFACILITY TYPE:
850
ADDRESS:3443 S. NOGALES STREETTELEPHONE:
(626) 965-9611
CITY:WEST COVINASTATE: CAZIP CODE:
91792
CAPACITY:60CENSUS: 44DATE:
11/18/2021
UNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Margie Zarate, DirectorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Child's authorized representative not notified of the injury
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Thelma Razo conducted a subsequent complaint inspection to deliver findings on the allegation of "Child's authorized representative not notified of the injury".
During this investigation, interviews were conducted with 5 staff, 7 parents and 4 children.
Facility has a Family Handbook which is a guide to the center's programs and operational procedures. It has indicated that if the child is injured, Incident/Accident Report will be given at pick up time. Staff interviewed have disclosed that an incident report is written manually in duplicate, one is given to the parent/guardian after they sign it, the duplicate copy is kept in the center.
During the inspection on 10/28/2021, LPA observed an incident report dated 10/27/2021 in duplicate in the Director's office with no parent/guardian signature. Staff #4 confirmed that the incident was not given to the parent/guardian due to parent sometimes rush out or staff have not seen the parent. LPA reviewed incident reports for the month of October of 2021, a total of 16 reports. LPA observed 2 out of 16 reports did not have signature of parent/guardian (10/18/2021 and 10/27/2021), a third one dated 10/13/2021 was signed the following day. Per written incident reports, two required administration of first aid by staff (10/13/2021 and 10/28/2021). Staff #1 confirmed that the incident of 10/18/2021 required administration of first aid.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
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 4
Control Number 33-CC-20211021161351
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 198003097
VISIT DATE: 11/18/2021
NARRATIVE
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Based on LPA’s observations and interviews which were conducted and record review, the preponderance of the evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 is being cited on the attached LIC9099D.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Director Margie Zarate.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 33-CC-20211021161351
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 198003097
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/18/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/29/2021
Section Cited
CCR
101226(a)(2)
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Health-Related Services
In the case of less serious injuries including, but not limited to, minor cuts, scratches and bites from other children requiring assessment and/or administration of first aid by staff, the licensee shall document the injury in the child's record and notify the child's authorized representative of the nature
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Director is to submit to LPA by due date, a plan to address the reporting requirement as indicated on Section 101226(a)(2).
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of the injury when the child is picked up from the center. This requirement was not met as evidenced by: Staff #4 admitted that the incident report dated 10/27/2021 was not given to the parent during pick up. Evidence has revealed that 2 out of 16 incident reports were not signed by parent/guardian, one was signed the following day. Three of the incidents required administration of first aid by staff. This poses a potential health and safety risk to 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: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4