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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073401306
Report Date: 11/14/2022
Date Signed: 11/14/2022 01:05:30 PM

Document Has Been Signed on 11/14/2022 01:05 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
073401306
ADMINISTRATOR:PAMELA SOUZAFACILITY TYPE:
850
ADDRESS:4308 FOLSOM DRIVETELEPHONE:
(925) 754-3137
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY: 72TOTAL ENROLLED CHILDREN: 52CENSUS: 24DATE:
11/14/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jamari FredenburgTIME COMPLETED:
01:05 PM
NARRATIVE
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On 11/14/22 at 11:00AM Licensing Program Analyst (LPA) Michelle Sutton conducted an unannounced Case Management inspection at Kindercare Learning Center about an unusual incident self reported by the Center on 10/27/22 about a teacher interfering with a child's sleeping during nap time. LPA met with director Jamari Fredenburg and explained the purpose of today's inspection.

LPA interviewed staff, received Copies of The Children's Roster and Personnel Report LIC500. The facility conducted their own investigation and during LPA's inspection, it was determined that Child 1 was forced to wake up from their nap by S1. Facility is being cited Type B for violating Personal Rights.

The following deficiency was observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the director Jamari Fredenburg.



SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2022
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 11/14/2022 01:05 PM - It Cannot Be Edited


Created By: Michelle Sutton On 11/14/2022 at 11:54 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 073401306

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/28/2022
Section Cited
CCR
101223(a)(3)

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101223 Personal Rights (a) The licensee shall ensure [..]personal rights:(3)To be free from corporal [..] interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning. This requirement is not met as evidence by;
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By POC date 11/28/22 director will submit a written statement understanding CCLD regulation for Personal Rights.
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Based on interviews, it was confirm that Child 1 was forced to wake up from napping.This is a potenial risk to Health and Safety or Personal Rights risk to persons in care.
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Facility will conduct a staff meeting about personal rights. Director will submit proof of agenda and signature from staff meeting.

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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:Sherelle Johnson
LICENSING EVALUATOR NAME:Michelle Sutton
LICENSING EVALUATOR SIGNATURE:
DATE: 11/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/14/2022


LIC809 (FAS) - (06/04)
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