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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334830641
Report Date: 07/14/2023
Date Signed: 07/14/2023 11:34:54 AM

Unsubstantiated


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
06/28/2023 and conducted by Evaluator Giselle Carbullido
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20230628155641
FACILITY NAME:KIDD STREET PRESCHOOL OF RIVERSIDEFACILITY NUMBER:
334830641
ADMINISTRATOR:MARIA TEELFACILITY TYPE:
830
ADDRESS:10250 KIDD STREETTELEPHONE:
(951) 688-4242
CITY:RIVERSIDESTATE: CAZIP CODE:
92503
CAPACITY:28CENSUS: 7DATE:
07/14/2023
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Lucy CasillasTIME COMPLETED:
11:40 AM
ALLEGATION(S):
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Unexplained injuries
INVESTIGATION FINDINGS:
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On the date and time listed above, Licensing Program Analyst (LPA) Giselle Carbullido arrived at the facility to investigate in regard to the above complaint received on 06/28/23. An initial visit was conducted on 06/30/23 at which time LPA conducted interviews and reviewed records. LPA was given access to the facility by the Director, Lucia Casillas. LPA discussed purpose of visit, took census, and toured the facility. LPA met with the Director to further discuss the complaint allegations and deliver findings.

It was alleged an infant sustained an unexplained injury (scratch) on 06/27/23. During the investigation, LPA interviewed all pertinent parties including facility staff and RP.
All interviews denied having any knowledge of how infant sustained a scratch and reported conflicting information on when/where scratch was possibly sustained. All interviews identified an approximate 2-hour gap in time from departure at approximately 5:20pm from facility to discovery of scratch at approximately 7:30pm in the home.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023
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 09-CC-20230628155641
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: KIDD STREET PRESCHOOL OF RIVERSIDE
FACILITY NUMBER: 334830641
VISIT DATE: 07/14/2023
NARRATIVE
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Records confirmed departure time at 5:15PM and observation of scratch at 7:28pm. Additionally, facility infant daily reports note no injury sustained on 06/27/23 or the day prior.
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Due to information obtained, LPA was unable to determine if an infant sustained an injury while in care from what was reported. Therefore, the evidence collected was not sufficient to substantiate or refute the above allegation. 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 the allegation is UNSUBSTANTIATED.

Appeal rights issued and discussed with licensee and their signature on this form acknowledges receipt of these rights.

An exit interview was conducted, a copy of this report and Notice of Site Visit was provided to Lucia Casillas. THIS REPORT MUST BE AVAILABLE TO THE PUBLIC FOR THREE YEARS.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2