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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343602991
Report Date: 06/05/2023
Date Signed: 06/14/2023 10:46:20 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/04/2023 and conducted by Evaluator Jennifer Velasco
COMPLAINT CONTROL NUMBER: 03-CC-20230504094017
FACILITY NAME:KINDERCARE LEARNING CENTER - LEXINGTON (PS)FACILITY NUMBER:
343602991
ADMINISTRATOR:GALVAN, NANCYFACILITY TYPE:
850
ADDRESS:295 S. LEXINGTON DRIVETELEPHONE:
(916) 983-6169
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:72CENSUS: 1DATE:
06/05/2023
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Kimberly StribikTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Day-care child sustained an unexplained injury while in care.
Facility did not notify parent of an incident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst Jennifer Velasco (LPA) met with Facility Representative Kimberly Stribik (D1) to deliver findings. LPA toured the facility, including all activity and classroom spaces, restrooms, food service and outdoor play areas. Census included 43 preschool children being supervised by 6 classroom staff. Director was reminded never to exceed the conditions, limitations, and capacity specified on the license. Facility hours of operation are Monday through Friday from 6:00 AM to 6:30 PM.
It was alleged a day care child (C1) sustained an unexplained injury while in care. It was also alleged facility staff did not notify the parents of an incident. During the investigation, LPA conducted interviews, observed care, and obtained relevant and reviewed documentation. Witness statements and photographic and other evidence showed C1 did sustain unexplained injury while in care and showed staff failed to notify C1's parents of the incident. Witness statements, observation, and documentary and photographic reviews corroborated the allegations. The preponderance of evidence standard has been met, and the allegations are substantiated.
Title 22 deficiencies were cited during today's inspection as documented on continuation page LIC 9099-D. This report was reviewed with D1, and an exit interview was conducted. Appeal Rights were provided. A Notice of Site Visit (NOS) was provided to Director who will post it for a period of 30 days for parental review.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2023
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 03-CC-20230504094017
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: KINDERCARE LEARNING CENTER - LEXINGTON (PS)
FACILITY NUMBER: 343602991
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/05/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/30/2023
Section Cited
CCR
101229(a)(1)
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(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time ... Supervision shall include visual observation. This requirement was not met, as evidenced by: witness statements and
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Facility representative (D1) stated they will provide a detailed written plan for ensuring staff provide care and supervision necessary to meet children's needs. D1 stated they will email this detailed written plan, training materials,
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photographic evidence that C1 did sustain injury in care. This is a potential risk to health, safety and or personal rights of children in care.
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and staff signatures they have received the training to LPA via email on or before the POC due date at

jennifer.velasco@dss.ca.gov
Type B
06/30/2023
Section Cited
CCR
101226(a)
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(a) The licensee shall immediately notify the child's authorized representative if the child becomes ill or sustains an injury more serious than a minor cut or scratch. The licensee shall obtain specific instructions from the authorized representative regarding action to be taken. This requirement was not
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Facility representative (D1) stated they will provide a detailed written plan for ensuring staff notify parents of incident/injuries in a timely manner. D1 stated they will email this detailed written plan, training materials, and
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met as evidenced by witness statements and documentation that, when a child became injured in care, staff failed to provide authorized representative with an incident/injury report. This is a potential risk to health, safety and or personal rights of children in care.
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staff signatures they have received the training to LPA on or before POC due date via email at

jennifer.velasco@dss.ca.gov
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: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2