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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013412610
Report Date: 05/20/2022
Date Signed: 05/26/2022 12:05:37 PM

Document Has Been Signed on 05/26/2022 12:05 PM - 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:
013412610
ADMINISTRATOR:CATHERINE BOLLINGERFACILITY TYPE:
830
ADDRESS:4655 LASSEN ROADTELEPHONE:
9254551560
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY: 36TOTAL ENROLLED CHILDREN: 36CENSUS: 8DATE:
05/20/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Claudia ArgeutaTIME COMPLETED:
12:10 PM
NARRATIVE
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On 5/20/22, approximately 8:15 am, LPA Simerjit Kaur arrived at the facility for unannounced case management inspection. LPA Kaur met with Facility Director, Claudia Argeuta. Present during the inspection were 8 staff and 2 infant children. The infant component operates out of 2 classrooms: infant classroom and toddler classroom. Upon entry the facility, LPA Kaur observed 4 infants in red color, 4 seater stroller outside the classroom with facility cook/volunteer without direct supervision. Per facility director, supervision was provided as she was watching the children and cook/volunteer through the glass window. LPA reviewed the sign in/out sheets to confirm the number of infants during that time.

See 809D for deficiency. Appeal rights and Notice of site visit provided.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/20/2022
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 05/26/2022 12:05 PM - It Cannot Be Edited


Created By: Simerjit Kaur On 05/20/2022 at 11:24 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: 013412610

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/20/2022
Section Cited
HSC
101416.3(b)

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(b) An infant care aide shall work under the direct supervision of the director, the assistant director or a fully qualified teacher, except as provided for in Section 101416.5(d)(1).

Based on observation, the licensee did not comply with the section cited above in which poses/posed a potential
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Facility director shall provide proof of on job training for aide and will ensure that all aides are under the direct supervision of a teacher or director at all times, when caring for infants. Facility director will submit a plan to LPA 6/20/22, which indicates how she will ensure that aides are always under the direct supervision of a teacher or a director.
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health, safety or personal rights risk to persons in care. During the inspection around 8:15am, LPA Kaur observed 4 infants in red color, 4 seater stroller outside the classroom with facility cook/volunteer without direct supervision.
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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: 05/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2022


LIC809 (FAS) - (06/04)
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