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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364804214
Report Date: 06/04/2021
Date Signed: 06/04/2021 09:34:44 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
05/24/2021 and conducted by Evaluator Patricia Berry
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20210524135831
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
364804214
ADMINISTRATOR:MELINDA GASKINFACILITY TYPE:
850
ADDRESS:10191 FOOTHILL BLVDTELEPHONE:
(909) 989-6136
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY:72CENSUS: 52DATE:
06/04/2021
UNANNOUNCEDTIME BEGAN:
08:36 AM
MET WITH:Catherine Matus/Assisstant DirectorTIME COMPLETED:
10:07 AM
ALLEGATION(S):
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Neglect/Lack of Supervision resulting in a child sustaining a fracture to the wrist.
INVESTIGATION FINDINGS:
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On 6/4/2021 at 8:36 AM Licensing Program Analyst (LPA) Patricia Berry conducted a complaint investigation to deliver final findings. LPA met with assistant director and assistant director granted LPA access into the facility. LPA toured facility and took census. LPA observed 52 children in day care program.

Allegation: Neglect/Lack of Supervision resulting in a child sustaining a fracture to the wrist.
A daycare child fell from the slide of a play structure, causing the child to sustain a fractured wrist. During the investigation, the LPA interviewed all pertinent parties, including staff who stated they witnessed the incident. Staff stated the child was climbing up the slide, while another child was climbing down the slide. Staff stated both children collided in the middle of the slide, which caused the child climbing up the slide to fall and land on the turf below.

(Cont on 9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2021
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 09-CC-20210524135831
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: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 364804214
VISIT DATE: 06/04/2021
NARRATIVE
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Staff stated in addition to one staff witnessing the incident, other staff were walking around the playground, providing supervision to children on the playground.

Based on information obtained during interviews, although a child did sustain a fracture; the incident may or may not have been a result of negligence or lack of supervision. Therefore, based on information received, the above allegation is determined to be unsubstantiated meaning 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.



Exit interview conducted with assistant director and report given.

LPA observed assistant director post LIC 9213- Notice of site visit.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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