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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364807782
Report Date: 03/14/2023
Date Signed: 03/14/2023 03:37:04 PM

Document Has Been Signed on 03/14/2023 03:37 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:
364807782
ADMINISTRATOR:DIEHL, JENNIFERFACILITY TYPE:
830
ADDRESS:15928 LOS SERRANOS COUNTRY CLBTELEPHONE:
(909) 606-7744
CITY:CHINO HILLSSTATE: CAZIP CODE:
91709
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 8DATE:
03/14/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Jennifer Diehl, Director TIME COMPLETED:
03:50 PM
NARRATIVE
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Licensing Program Analysts(LPAs) Elyse Jones and Blanca Ruiz arrived at the facility to conduct a Case Management inspection for the purpose of addressing separate matters that were discovered during an inspection at the facility. During the inspection LPAs conducted a tour of the facility and census were taken. LPAs observed C1 sleeping face down (on stomach). LPAs reviewed C1s LIC 9227 and section C was not filled out and signed by the Authorized Representative.

See LIC 809-D for deficiency cited

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.

Exit interview conducted and report was reviewed with Jennifer Diehl, Director.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Elyse Jones
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2023
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 03/14/2023 03:37 PM - It Cannot Be Edited


Created By: Elyse Jones On 03/14/2023 at 03:17 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: 364807782

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/17/2023
Section Cited
CCR
101429(a)(2)(B)3a

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Responsibility for Providing Care and Supervision for Infants
(a) In addition to Section 101229, the following shall apply: (2)Sleeping infant(s) shall be directly observed by sight and sound at all times. 3.Infants up to 12 months of age who are sleeping in a position other than on their back.
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Director agrees to have C1s Authorized Representative completed and sign Section C and submit to the Department by POC due date. Director also agrees to review all files for infants under 12 months to ensure their forms are filled out if they have the ability to roll over.
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a. If the infant’s Individual Infant Sleeping Plan [LIC 9227 (3/20)] does not have Section C completed, staff shall return the infant to their back for sleeping.
This requirement was not met as evidenced by: During inspection LPAs observed C1 sleeping face down and did not have Section C on the LIC 9227 completed and signed.
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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:Elyse Jones
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2023


LIC809 (FAS) - (06/04)
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