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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334809083
Report Date: 05/20/2022
Date Signed: 05/20/2022 10:03:47 AM

Document Has Been Signed on 05/20/2022 10:03 AM - 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
334809083
ADMINISTRATOR:TARA MARTINEZFACILITY TYPE:
830
ADDRESS:610 E. NUEVO ROADTELEPHONE:
(951) 943-6476
CITY:PERRISSTATE: CAZIP CODE:
92571
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 22DATE:
05/20/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:52 AM
MET WITH:Tara MartinezTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Sumayya Habeebulla made a Plan of Correction (POC) visit this date to ensure deficiencies cited during Annual Inspection conducted on 04/08/22 has been corrected. During the visit, LPA toured the facility, took census and met with the Director, Tara Martinez, who was informed of the reason for the premise visit.

On 04/08/2022 during an annual inspection the facility was cited for the following deficiencies and the corrections were not submitted by the POC due date of 05/09/2022. LPA emailed the director on 05/09/2022 alerting her of the pending POCs. LPA did not receive any response from the Director and therefore LPA followed up with a phone call on 05/16/2022 and left a voicemail requesting the Director to call back in order to work on an extension date for the POCs. LPA did not receive any response. Deficiencies that are still pending are as follows -

1. MMR, TDAP, TB Test and Flu for S2 and S7 by the POC due date – Proof for S7 was received on 05/06/2022. Proof for S2 received during the visit.

2. LIC 503 for S2 and S7 by the POC due date - Proof for S7 was received on 05/06/2022. Director Tara Martinez and S2 stated they are in the process of obtaining LIC 503 from the Medical provider and will be submitting it to the department by the end of the day. The form has already been submitted to the medical provider and they are awaiting it to be faxed back. The department will be notified the receipt of the document.

An exit interview was conducted, and a copy of this report was provided to Tara Martinez (Director). A Notice of Site Visit was issued and the Licensee understands that it must remain posted for 30 days

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE: DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/20/2022
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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