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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364809076
Report Date: 10/17/2022
Date Signed: 10/17/2022 04:01:13 PM

Document Has Been Signed on 10/17/2022 04:01 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:
364809076
ADMINISTRATOR:ALISA HOLTEGARRDFACILITY TYPE:
840
ADDRESS:960 W. BLOOMINGTONTELEPHONE:
(909) 877-3399
CITY:BLOOMINGTONSTATE: CAZIP CODE:
92316
CAPACITY: 42TOTAL ENROLLED CHILDREN: 42CENSUS: 23DATE:
10/17/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Alisa Holtegarrd TIME COMPLETED:
04:05 PM
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On 10/17/2022 at time listed above Licensing Program Analysts (LPA) Justin Giese conducted an unannounced visit to the facility to follow up on the submission of an Unusual Incident Report (UIR) that was received by the Regional Office on 10/05/2022 and processed on 10/10/2022. The UIR documented an incident concerning a child sustaining an injury needing medical attention.

LPA met with Facility Directior, Alisa Holtegarrd to discuss the purpose of the visit. During this visit, LPA toured the facility, took census of children present and conducted interviews. The subject child involved in the incident was not present during todays visit.

More time is needed to complete the investigation. Upon completion of the investigation the findings will be shared with the Director.

An exit interview was conducted, LPA provided the Director with a copy of this report and a notice of site visit on 10/17/2022.

Notice of site visit must be displayed for the next 30 days.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Justin Giese
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2022
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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