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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270341
Report Date: 01/19/2023
Date Signed: 01/19/2023 12:28:11 PM

Document Has Been Signed on 01/19/2023 12:28 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:
304270341
ADMINISTRATOR:STAHL, VANESSAFACILITY TYPE:
840
ADDRESS:3223 ASSOCIATED ROADTELEPHONE:
(714) 990-6924
CITY:FULLERTONSTATE: CAZIP CODE:
92835
CAPACITY: 28TOTAL ENROLLED CHILDREN: 26CENSUS: 0DATE:
01/19/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Vanessa Stahl, DirectorTIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analyst (LPAs) Patricia Rivas conducted a case management visit. LPA met with Vanessa Stahl, to discuss the Lead Sampling Testing conducted on 12/03/2022. Director was advised on 01/17/2023 to post the Lead Sample Report . Facility staff had previously provided LPA copies of all documentation requested regarding Lead; LIC 999 Facility Sketch, LIC 9275 and LIC 9276. LPA confirmed that Director had posted the Lead Sample Report . Director reports she posted report in November 2022.
Census was taken Total of 0 Teachers and 0 children observed in Room 10
A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Facility was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018 requires all licensed Child Care Centers (CCC’s) constructed before January 1, 2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every five years after the date of the first test. Community Care Licensing was notified that lead water testing conducted at the facility on 12/03/2022 failed allowable limit for lead. The purpose of today’s visit is to follow up lead testing results of Action Level Exceedance (ALE) on Outlets K (ALE 7) Rm 10 teacher's fountain not used for consuming water and N(ALE 29) in kitchen not used to consume water.

Instructions for required lead testing are outlined in PIN 21-21.1-CCP (Supersedes PIN 21-21-CCP) This PIN which contains Written Directives, have the same force and effects as the regulations contained in Title 22 of the California Code of Regulations.

cont. on page 2

SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2023
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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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: 304270341
VISIT DATE: 01/19/2023
NARRATIVE
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LPA observed outlet K(teacher's hand washing sink in Rm 10 ALE 7.0) and N (In kitchen sink for sanitizing ALE 29) Director made outlets inaccessible via signs and plastic bags. Director reports there are other sinks in rooms 10 and kitchen that will be utilized for hand washing and sanitizing respectively.


Based on LPA's observation and interview with Director, Vanessa Stahl the following violation was observed and is being cited in accordance with Written Directives Section 101700.3 (b)(1) California Lead Action Level at Child Care Centers, is being cited on the attached LIC 809D.

An exit interview was conducted with Director Stahl. Appeal Rights were explained. The Director was provided a copy of appeal rights (LIC 9058) 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the Regional Manager to the address listed.



The Notice of Site Visit was given and discussed it must be posted as required by H & S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00.
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/19/2023 12:28 PM - It Cannot Be Edited


Created By: Pat Rivas On 01/19/2023 at 10:51 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 304270341

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/20/2023
Section Cited

101700.3(b)(1)

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101700.3 (b) Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole number, before comparing to the Action Level.
(1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
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During visit, LPA confirmed lead results were posted, and lead documents were submitted. Director will remove, replace or repair outlet P& Q and will submit plan of correction by 02/20/2023.
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This requirement is not met evidenced by record review of the lab report analysis from Outlets K(ALE 7 rm 10 ) & N(ALE29 kitchen) taken on 12/03/2022. Results indicated levels of lead in exceedance at 5.6 This poses a potential risk to the health and 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:Rina Lopez
LICENSING EVALUATOR NAME:Pat Rivas
LICENSING EVALUATOR SIGNATURE:
DATE: 01/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2023


LIC809 (FAS) - (06/04)
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