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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013415772
Report Date: 07/03/2024
Date Signed: 07/03/2024 12:08:22 PM

Document Has Been Signed on 07/03/2024 12:08 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
013415772
ADMINISTRATOR/
DIRECTOR:		SCOTT KINSERFACILITY TYPE:
850
ADDRESS:11925 AMADOR VALLEY COURTTELEPHONE:
(925) 875-0400
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 108TOTAL ENROLLED CHILDREN: 108CENSUS: 40DATE:
07/03/2024
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Director, Kinser ScottTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Jyoti Saini met with Director Scott Kinser for a UNANNOUNCED REQUIRED RANDOM INSPECTION OF THE PRESCHOOL COMPONENT OF THIS COMBINATION DAY-CARE CENTER. LPA disclosed the purpose of the inspection and was granted entry into the facility by the staff. In addition to the director, 40 children and six (6) staff members are present today. The facility operates Monday - Friday from 7:00 am – 6:00 pm out of Pre-K, Pre-A, Pre-B, and Pre-C, classrooms.
The facility was inspected indoors and outdoors today for health and safety hazards, and the following was observed:There is a working fire alarm system. The room has a working smoke and carbon monoxide detector, a fully charged fire extinguisher, and a working telephone available. There are no bodies of water, firearms, or weapons on the premises. All furniture is in good repair. A first aid kit and a first aid backpack are available. The outdoor play area is fenced for supervision. The play structure is age-appropriate and in good condition, with sufficient cushioning underneath. The classroom has appropriate postings. The last Emergency Drill was conducted on 06/03/2024 and is properly logged. Medications are stored on a high shelf, inaccessible to children in care. The menu is posted in a visible location. The program provides daily snacks and lunch. LPA reviewed the food storage and reminded the director that all food must be in original packaging or labeled with an expiration date. LPA reviewed the sign-in and out sheet. The center has a complete record of sign-in/out sheets by an authorized pick-up person.
The center roster was reviewed, and a copy was obtained. A review of 6 children's files and eight staff files was completed. All children have a record of emergency identification information and immunization records on file. All staff has a criminal record clearance on file. The opening and closing staff have a current Pediatric First Aid/CPR certificate on file.
See the next page.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 07/03/2024 12:08 PM - It Cannot Be Edited


Created By: Jyoti Saini On 07/03/2024 at 11:17 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: 013415772

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/03/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in 2 out of 8 staff did not have proof of Pertussis and MMR which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/24/2024
Plan of Correction
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Facility representative shalll have staff provide proof of MMR and pertussis by due date to the department.
Failure to correct will result in a $100.00 per day civil penalty until corrected. Repeat violations are 250.00 per violation and $100.00 per day until corrected.
Type B
Section Cited
CCR
101226(e)(3)(A)
Health-Related Services
(3) Prescription medications may be administered if all of the following conditions are met: (A) Prescription medications shall be administered in accordance with the label directions as prescribed by the child's physician.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above . C6's epipen was found to be expired, which poses a potential health, safety or personal rights risk to children in care.
POC Due Date: 07/05/2024
Plan of Correction
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The director shall return the expired EpiPen to the parents and obtain un-expired EpiPen. All Incidental Medical Plans should be followed and medications checked on a regular basis to ensure that no medications become expired.
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: 07/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/03/2024


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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 013415772
VISIT DATE: 07/03/2024
NARRATIVE
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During inspection,

Criminal Record Clearance -

Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Lead Testing –


CCC COMPLETED TESTING AND IS IN THE PROCESS OF REMEDIATING LEAD EXCEEDANCES
Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.
Incidental Medical Services (IMS)
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and
administrative records.
For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

MyChildCarePlan.org
Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.
see next page..
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 013415772
VISIT DATE: 07/03/2024
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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

The attached two type B deficiencies were cited today and two technical violations were given.



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


Exit interview conducted and report was reviewed with the facility representative, Scott Kinser.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024
LIC809 (FAS) - (06/04)
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