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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364807781
Report Date: 10/22/2021
Date Signed: 11/01/2021 01:45:42 PM

Document Has Been Signed on 11/01/2021 01:45 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:
364807781
ADMINISTRATOR:DIEHL, JENNIFERFACILITY TYPE:
840
ADDRESS:15928 LOS SERRANOS COUNTRY CLBTELEPHONE:
(909) 606-7744
CITY:CHINO HILLSSTATE: CAZIP CODE:
91709
CAPACITY: 52TOTAL ENROLLED CHILDREN: 52CENSUS: 17DATE:
10/22/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:33 PM
MET WITH:Jennifer DiehlTIME COMPLETED:
05:20 PM
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THIS IS AN AMENDMENT. THE INSPECTION WAS CONDUCTED ON 10/29/2021 AND THE ORIGINAL FACILITY EVALUATION REPORT WAS SIGNED BY THE LPA AND THE FACILITY DIRECTOR ON THE DATE OF THE INSPECTION ON 10/29/2021. HOWEVER, THE VISIT DATE AT THE TOP OF THIS REPORT WHICH IS NOT EDITABLE SHOWS 10/22/2021 WHICH IS INCORRECT. THIS AMENDMENT IS TO NOTE THE CORRECT DATE OF THE INSPECTION. THIS REPORT WAS SIGNED AGAIN BY BOTH PARTIES ON 11/1/2021, THE DATE THIS AMENDMENT WAS ISSUED.

Licensing Program Analyst (LPA) Kim Leung conducted a case management visit at the facility this date on 10/29/2021 in response to the receipt of an unusual incident report (UIR) from the facility regarding possible personal rights violation. The UIR was received by the licensing agency on 10/19/2021.

Upon arrival, LPA met with facility director Jennifer Diehl and stated the purpose of the visit. Facility records were reviewed and interview was conducted. Further information is needed. Upon completion of the review, the outcome and/or recommendations will be provided to the director.

An exit interview was conducted with director Jennifer Diehl and a copy of this report was provided to facility staff. Notice of Site Visit was issued and must be posted up at the facility for 30 days.

A copy of this report must be made available to the public, at the facility site, for 3 years.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Kim Leung
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2021
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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