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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013412608
Report Date: 02/14/2023
Date Signed: 02/14/2023 11:47:14 AM

Document Has Been Signed on 02/14/2023 11:47 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
013412608
ADMINISTRATOR:JAMIE CZELUSNIAKFACILITY TYPE:
850
ADDRESS:4655 LASSEN ROADTELEPHONE:
(925) 455-1560
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 36DATE:
02/14/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Jamie CzelusniakTIME COMPLETED:
12:00 PM
NARRATIVE
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On February 14 , 2023, Licensing Program Analyst (LPA) Simerjit Kaur conducted a case management inspection due to the center's lead testing results. LPA met with facility director Jamie Czelusniak. Present during the inspection, were 36 children and 4 staff members present.

The department was notified that water faucet “B30” located in the kitchen under preschool component and faucet "F" in the preschool age classroom, have elevated lead levels that have exceeded 5.5 ppb. This exceeds the Action Level (ALE) established by the state for lead exposure. Per facility director, the faucet is immediately closed off and work order has been placed to replace the faucet. LPA observed today the faucet is closed and not in use. LPA also observed posting of lead testing results.

See LIC809 D for deficiency cited during today's inspection.



Exit interview conducted with facility director Jamie Czelusniak. A notice of site visit was provided and must be posted for 30 days. Appeal rights provided.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/14/2023 11:47 AM - It Cannot Be Edited


Created By: Simerjit Kaur On 02/14/2023 at 10:26 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 013412608

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/14/2023
Section Cited

101700.3(b)(1)

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101700.3(b)(1)-Lead Testing Written Directive-
A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance (ALE)
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LPA observed the 2 water outlets have been closed. facility director Jamie Czelusniak is advised to submit re-test results to LPA by due date of 03/07/2023.
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This requirement is not met as evidenced by:
Based on record review, the facility has 2 outlets ("B30 and F") that have an ALE of ppb or greater, which poses a potential health and safety risk to persons 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.
SUPERVISOR'S NAME:Jason Jang
LICENSING EVALUATOR NAME:Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2023


LIC809 (FAS) - (06/04)
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