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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364807780
Report Date: 11/14/2024
Date Signed: 11/14/2024 12:41:50 PM

Document Has Been Signed on 11/14/2024 12:41 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
364807780
ADMINISTRATOR/
DIRECTOR:		AMY HALITFACILITY TYPE:
850
ADDRESS:15928 LOS SERRANOS COUNTRY CLBTELEPHONE:
(909) 606-7744
CITY:CHINO HILLSSTATE: CAZIP CODE:
91709
CAPACITY: 98TOTAL ENROLLED CHILDREN: 98CENSUS: 32DATE:
11/14/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:55 AM
MET WITH:Director Amy Halit and Director Millie BoychuckTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On the above date and time, Licensing Program Analysts (LPAs) Susan Brewer, Chase Atherton and Giselle Carbuilldo, conducted an unannounced case management visit at the facility for the purpose of concluding an inspection pertaining to the facility's submission of an Unusual Incident Report (UIR) received by Licensing on 11/04/2024. The UIR outlined an incident that occurred on 10/31/2024 at approximately 3:59 PM, pertaining to Lack of Supervision of a subject child in care. LPAs were granted entry into the Facility and met with Facility Director, Amy Halit. Director Millie Boychuk, arrived at the facility and joined the inspection.

During the inspection, LPAs toured the facility, conducted interviews, and obtained photos. Interviews revealed a subject child wandered from the Twos classroom unsupervised and then entered a 2nd door leading to the Threes classroom, which is adjacent school age classroom. Information gathered through interviews conducted with pertinent parties reported the subject child remained unsupervised for approximately 2-3 minutes and reported missing to facility management, who later found the subject child unattended in the school age classroom. Based on LPA's interviews conducted with pertinent parties and evidence collected, it was confirmed that a subject child was left unsupervised while in care.

The Facility was found to be in violation of the following Title 22 Regulation 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, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This is a repeat violation.

Licensing Program Analysts (LPAs) Susan Brewer, Chase Atherton and Giselle Carbuilldo, informed Directors Amy Halit and Millie Boychuk, that this report dated 11/14/2024 documents a repeat Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care. A civil Penalty was issued for a repeat violation in the amount of $1,000.00.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2024
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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 364807780
VISIT DATE: 11/14/2024
NARRATIVE
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IF a Civil Penalty has been assessed during this inspection. Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”. YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.

Also, Licensing Program Analysts (LPAs) Susan Brewer, Chase Atherton and Giselle Carbuilldo, informed the Directors Amy Halit and Millie Boychuk, to provide a copy of this licensing report dated 11/14/2024 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.


See LIC809D for Type A deficiency Cited during this inspection.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted, the report was reviewed and a copy of the report was left with the Director Amy Halit and Millie Boychuk
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/14/2024 12:41 PM - It Cannot Be Edited


Created By: Susan Brewer On 11/14/2024 at 10:48 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 364807780

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/15/2024
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 & supervision as necessary to meet the children's needs; (1).... Supervision shall include visual observation.
This requirement was not met as evidenced by:
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This is a repeat violation. The facility director agrees to submit a statement of understanding the Responsibility for Providing Care and Supervision at all times for all children in care.
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Based on evidence gathered through interviews, documentation obtained & the agency's self-reported notification that a child was left unsupervised on 10/31/2024 for 2-3 minutes, This is an immediate risk to the health and safety of children in care.
A civil penalty was issued for $1,000.00
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In addition, the director agrees to submit written plan to ensure 100% Supervision and steps to implement the plan of action, curriculum provided to staff, on or before the close of business day on 11/15/2024.

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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:Ana Noble
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 11/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/14/2024


LIC809 (FAS) - (06/04)
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