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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013415772
Report Date: 01/31/2023
Date Signed: 01/31/2023 03:24:16 PM

Document Has Been Signed on 01/31/2023 03:24 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:
013415772
ADMINISTRATOR:WOOLSEY, SIERRAFACILITY TYPE:
850
ADDRESS:11925 AMADOR VALLEY COURTTELEPHONE:
(925) 875-0400
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 108TOTAL ENROLLED CHILDREN: 108CENSUS: 74DATE:
01/31/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Director, Scott, KinserTIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jyoti Saini met with Director Scott Kinser to conduct a Case Management inspection for the Lead Testing results at this facility. In addition to the director, there are 74 children and 10 staff members present today. The facility operates Monday - Friday from 7:00am to 6:00pm.

LPA conducted an inspections and Inspected the facility for health and safety. It was concluded that four outlet exceeded the Action Level that was established by the state for exposure. Two of the Faucets are located within an unoccupied classroom. LPA obtained photos of the faucets that has exceeded 5.5 ppb. LPA discussed a Plan of Correction and facility has submitted the documentation for the post-testing requirements.

The following deficiency is (See LIC 809-D)



A notice of site visit was given and must remain posted for 30 days. Appeal Rights provided.

Exit interview conducted and report was reviewed with the Director, Scott Kinser.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2023
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 01/31/2023 03:24 PM - It Cannot Be Edited


Created By: Jyoti Saini On 01/31/2023 at 01:46 PM
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: 013415772

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/31/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/28/2023
Section Cited
CCR
101700.3(b)(1)

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Lead Testing Written Directive
A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.This requirement is not met as evidenced by:
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The facility has already ceased using the outlets.The facility is in the process of replacing/reparing the outlet.Since the facility has opt to repair/replace the water outlet, a follow up water sample shall be taken following the lead testing protocol.
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Based on record review, the licensee did not comply with the section cited above 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:Wynn Norona
LICENSING EVALUATOR NAME:Jyoti Saini
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2023


LIC809 (FAS) - (06/04)
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