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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364804213
Report Date: 10/25/2023
Date Signed: 10/25/2023 04:59:02 PM

Document Has Been Signed on 10/25/2023 04:59 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
364804213
ADMINISTRATOR:MEGAN PEVELERFACILITY TYPE:
830
ADDRESS:2140 S. EUCLIDTELEPHONE:
(909) 983-5007
CITY:ONTARIOSTATE: CAZIP CODE:
91762
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: 15DATE:
10/25/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:50 PM
MET WITH:Megan Peveler TIME COMPLETED:
05:30 PM
NARRATIVE
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 Licensing Program Analysts (LPAs) Blanca Ruiz and Rachel Zeron arrived at the facility to conduct a Case Management inspection for the purpose of addressing separate matter that was discovered during an investigation of complaint 09-CC-20230925150956. LPAs met with, Administrator, Megan Peveler. Prior visits were conducted on 09/27/23 and 09/29/23, during this visit, LPAs conducted a tour of the facility and census was taken.

During visits conducted at the facility, it was learned that an infant who is no longer attending the facility had two separate incidents that lead to a head injury. Child received medical treatment for both injuries. Parent(s)/Legal guardian(s) informed and contacted the facility via phone, e-mail to obtained additional information pertaining to how the incident occurred and what precautions failed for their infant to end up with injuries with her first week(s) attending the facility but no follow up was received. However, facility returned tuition and daycare services ceased. Facility failed to report the second child’s injury to Community Care Licensing.

The following deficiencies were cited:

101212(d)(1)(C) Reporting Requirements. Any unusual incident or child absence that threatens the physical or emotional health or safety of a child shall be reported to the Department within 24 hours of the occurrence. The center failed to report the incident of Child#1 to community care licensing (CCL).

Please see Lic 809D for deficiency cited.

Exit interview conducted and report was reviewed with Site Director, Megan Peveler. A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.


Failure to comply with posting requirements shall result in an immediate civil penalty of $100
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Blanca Ruiz-Silva
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2023
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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Document Has Been Signed on 10/25/2023 04:59 PM - It Cannot Be Edited


Created By: Blanca Ruiz-Silva On 10/25/2023 at 02:50 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 364804213

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/27/2023
Section Cited
CCR
101212(d)(1)(C)

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101212(d)(1)(C) Reporting Requirements. Any unusual incident or child absence that threatens the physical or emotional health or safety of a child shall be reported to the Department within 24 hours of the occurrence.
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Director agrees to provide copy of UIR/LIC 624 pertaining to incident in question. Director also agree to provide training to staff regarding reporting requirements. Staff acknowledgment /signing sheet must be provided to CCL by deadline.
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This requirement was not met as: facility failed to report the second incident to Community Care Licensing within the allowed time. This posed an potential risk to the health, safety, or personal rights to the subject child and 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:Aaron Ross
LICENSING EVALUATOR NAME:Blanca Ruiz-Silva
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2023


LIC809 (FAS) - (06/04)
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