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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198008923
Report Date: 10/28/2021
Date Signed: 10/28/2021 02:05:39 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, 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
08/31/2021 and conducted by Evaluator Steven Rodriguez
COMPLAINT CONTROL NUMBER: 33-CC-20210831140824
FACILITY NAME:KIDDIE ACADEMY CHILD CARE LEARNING CENTERFACILITY NUMBER:
198008923
ADMINISTRATOR:CARMEN MILLNERFACILITY TYPE:
850
ADDRESS:663 E. FOOTHILL BLVD.TELEPHONE:
(909) 621-5112
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY:118CENSUS: 67DATE:
10/28/2021
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Cheyenne Cawl, Assistant DirectorTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff are not meeting day care child's dietary needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Steven Rodriguez conducted a subsequent complaint visit to complete the investigation on the above allegation. LPA met with staff and stated the purpose of the visit.
On 9/09/2021, LPA held an Initial 10-Day Visit and tour the facility which consists of eight classrooms, 120 kids enrolled and an outdoor play area. LPA interviewed 5 staff members and the School Director. LPA obtained a children's and staff roster, a food allergy chart and daily monthly lunch menu. On 09/28/2021, LPA interviewed 3 children at the facility and two additional staff members. LPA also obtained a copy of an updated food allergy chart, an updated daily monthly lunch menu, and an enrollment agreement.
Various interviews and verbal confessions have revealed that child #1’s dietary needs have not been met. Complaint alleges that child #1 became ill after being fed food that the child is allergic to. LPA interviewed the staff who consistently described how the food is handled and distributed to each child. There were no disclosures made during interviews. However, based on the verbal disclosures from staff interviewed, it was determined that child #1 was given a food product that had belonged to a prior enrolled child.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Steven Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
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 3
Control Number 33-CC-20210831140824
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: KIDDIE ACADEMY CHILD CARE LEARNING CENTER
FACILITY NUMBER: 198008923
VISIT DATE: 10/28/2021
NARRATIVE
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Per the director, child #2 contained a similar allergy to child #1 and therefore believed it to be okay to give the food product to child #1. Upon review of child #2’s file, it was determined that Child #2 contained a different allergy than Child #1.

Based on LPA’s observation, interviews and record reviews, 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 LIC9099-D.



The Notice of Site Visit was posted where the parent/guardian of children enter and exit the facility. This notice shall remain posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Exit interview held, copy of reports and Appeal Rights provided.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Steven Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 33-CC-20210831140824
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: KIDDIE ACADEMY CHILD CARE LEARNING CENTER
FACILITY NUMBER: 198008923
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/28/2021
Section Cited
CCR
101227(7)(b)
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Food services In child care centers providing meals to children, the following shall apply:
(7) Modified diets prescribed by a child's physician as a medical necessity shall be provided.
(B) A child shall not be served any food to which the child's record indicates he/she has an allergy.
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Please modify current allergy chart to specify food preferences or create seperate chart to include one for food allergies and one to include food preferences.

Please discard any food that was left behind by prior disenrolled children and continue to discard food as children disenroll from the facility.
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This requirement was not met as evidenced by the disclosure of staff indicating a child in care was provided food that belonged to another child and not adhering to specific guidelines as outlined within title 22 regulations. This is a potential risk to the health and safety of 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: Steven Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3