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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270339
Report Date: 08/11/2022
Date Signed: 08/11/2022 04:24:13 PM

Document Has Been Signed on 08/11/2022 04:24 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
304270339
ADMINISTRATOR:STAHL, VANESSAFACILITY TYPE:
850
ADDRESS:3223 ASSOCIATED ROADTELEPHONE:
(714) 990-6924
CITY:FULLERTONSTATE: CAZIP CODE:
92835
CAPACITY: 82TOTAL ENROLLED CHILDREN: 75CENSUS: 62DATE:
08/11/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Vanessa Stahl, DirectorTIME COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analysts (LPA) Torrence conducted a case management inspection to follow up on a self-report unusual incident that was submitted to CCL Regional Licensing Office on 08/02/2022. According to the self-reported incident, it was reported a staff discovered a child in a classroom alone. It was also reported there were three staff supervising 23 children, at the time, and was transitioning to go outside. It was also reported that staff members are conducting face to name check at the time and staff checked the classroom before closing the classroom door but did not know why staff did not see the child in the classroom. It was reported the child was left in the classroom approximately 4 minutes or less.

Census was taken. LPA observed 62 napping children, with 4 staff supervising. A review of staff records on this date indicates that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During today’s case management inspection, LPA Torrence interviewed five staff members. Staff 1(S1) stated Staff 2(S2) called her and told her a child was in the classroom alone. S1 stated by the time S2 called her it took about a minute to get to the classroom. Staff 2(S2) stated when she entered the classroom, she saw the child standing in the middle of the classroom, where they keep the puzzles. S2 stated she saw the child in the classroom between 4:10 pm-4:15 pm. Staff 3(S3) stated she was at the gate leading to the playground waiting for the children to be sent to her. S3 stated she counted the children as they passed through the gate. S3 think the child was left in the classroom between 1-5 minutes but wasn’t sure. Staff 4(S4) stated the transition to outside procedure is to line the children up on the edge of the window inside the classroom, do a name to face accountability, and then count the children as they walk through the door to go outside. S4 stated when she did the name to face the child was there; however, she believed when she counted the children as the went through the door, she missed counted and did not realize the child was missing. Staff 5(S5) stated she was the last person in the classroom helping another child put on their shoes, when they finished, she looked around the room and didn’t see the child in there.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE: DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/11/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 304270339
VISIT DATE: 08/11/2022
NARRATIVE
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Based on LPAs interviews, the following deficiency is being cited in accordance with California Code of Regulations Title 22, Division 12, Section 101229(a)(1) Responsibility for Providing Care and Supervision . Deficiency is being cited on the attached LIC 809D.

If the facility receives a Type 'A' violation the licensee shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file.

Exit interview was conducted. The Notice of Site Visit was posted. Facility representative was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal Rights was explained. A copy of appeal rights (LIC 9058 1/16) will be provided through email and their signatures on this form acknowledges receipt of these rights. First level appeal is to Regional Manager, address is above on the report.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/11/2022 04:24 PM - It Cannot Be Edited


Created By: Stacy Torrence On 08/11/2022 at 03:42 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 304270339

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/11/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/12/2022
Section Cited
CCR
101229(a)(1)

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101229(a)(1) REsponsibility for Providing Care and Supervision.(a)The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time…. Supervision shall include visual observation.
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Per director, they will have training covering name to face and transitioning training. Per director, she will email agenda and signature of staff who attended.
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This requirement is not met as evidence by: Based on interviews with staff members, it was discovered that a child was left in the classroom unattended. This poses an immediate risk to the safety of children 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:Thuy Ho
LICENSING EVALUATOR NAME:Stacy Torrence
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2022


LIC809 (FAS) - (06/04)
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