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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334845644
Report Date: 11/14/2022
Date Signed: 11/14/2022 02:19:09 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, 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
09/13/2022 and conducted by Evaluator Giselle Carbullido
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20220913095637
FACILITY NAME:KINGSTON ACADEMYFACILITY NUMBER:
334845644
ADMINISTRATOR:KAREN BRAZZILLFACILITY TYPE:
850
ADDRESS:6048 ETIWANDA AVENUETELEPHONE:
(951) 681-4182
CITY:MIRA LOMASTATE: CAZIP CODE:
91752
CAPACITY:72CENSUS: 14DATE:
11/14/2022
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Karen BrazzilTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Child not given blanket and pillow at nap time.
INVESTIGATION FINDINGS:
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On date and time listed above, Licensing Program Analyst (LPA) Giselle Carbullido arrived at the facility to conduct an unannounced inspection to deliver the findings of the above allegations. On 09/20/22 an initial inspection was completed; interviews were conducted, and records were obtained. During this inspection the LPA discussed the findings of the above allegations with the Licensee, Karen Brazzill.
Findings Summary of the following allegations: Child not given blanket and pillow at nap time. It was reported on 07/25/22 child was not given their blanket or pillow at nap time. Due to length of time passed between date of incident and reporting of incident facility was unable to provide video review for date reported. LPA interviewed 4 staff. Staff interviews stated they have not observed any child napping without their bedding and if a Parent forgets to bring back bedding for the week the facility has additional bedding that can be utilized if a child is without. Correspondence between RP and facility via Brightwheel APP does not reflect any concern or discussion of child not having a blanket/pillow for naptime.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022
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
Control Number 09-CC-20220913095637
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: KINGSTON ACADEMY
FACILITY NUMBER: 334845644
VISIT DATE: 11/14/2022
NARRATIVE
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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.
An exit interview was conducted, a copy of this report, appeal rights, and Notice of Site Visit was provided to the Director. LPA observed the Notice of Site Visit was posted by staff. THIS REPORT MUST BE AVAILABLE TO THE PUBLIC FOR THREE YEARS
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4