364809076-6-13-2023-09-CC-SBRR-CSS224-20230613170007

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364809076
Report Date: 06/13/2023
Date Signed: 06/13/2023 05:00:28 PM

Document Has Been Signed on 06/13/2023 05:00 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	KINDERCARE LEARNING CENTER		FACILITY NUMBER:	364809076
ADMINISTRATOR:	ALISA HOLTEGARRD		FACILITY TYPE:	840
ADDRESS:	960 W. BLOOMINGTON		TELEPHONE:	(909) 877-3399
CITY:	BLOOMINGTON	STATE: CA	ZIP CODE:	92316
CAPACITY: 28	TOTAL ENROLLED CHILDREN: 33	CENSUS: 17	DATE:	06/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:38 PM
MET WITH:	Director Alisa Holtegaard		TIME COMPLETED:	05:05 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 06/13/2023 at 2:38 PM Licensing Program Analyst (LPA) Susan Brewer arrived at the facility to conduct a 1 year required annual inspection. LPA was greeted and granted entry by Director Alisa Holtegaard. LPA toured the facility, inside and out, reviewed records, and observed and/or discussed the following: Normal days and hours of operation: Monday- Friday, 6:00 AM to 7:15 & 11:30 PM to 6:00 PM during the school year; 6:00 AM to 6:00 PM, during the summer. The inspection consisted of reviews of the following domains: Food Service Reporting Requirements Physical Plant, Care and Supervision Children Records, Staff Records Staffing Ratio and Capacity Personal Rights. The inspection found the facility to be in compliance in these domains, except as noted on the LIC809-D. A review of the staff records and children's records were conducted as part of this evaluation. The licensee is asked to update the following documents and submit to licensing within 30 days: Only if changes have been made: 1. LIC 500 Personnel Report 2. LIC 610 Emergency & Disaster Plan 3. Parent Handbook/ Program Curriculum/Admission policies and procedures/ fee schedule (only if changes have been made) 4. LIC 309 Administrative Organization 5. LIC 308 Designation of Administrative Responsibility

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KINDERCARE LEARNING CENTER	FACILITY NUMBER: 364809076
	VISIT DATE: 06/13/2023

NARRATIVE

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The following items have been posted and are updated where necessary:
- License, Emergency Disaster Plan (LIC610) and Earthquake Preparedness Checklist (LIC9148)
- Parent’s Rights Poster (PUB393), Personal Rights (LIC613A); Child Car Seat Law, Menu
· The facility is operating within the terms of the license on today's date.
· Facility is clean, safe and sanitary and in good repair.
· Ratios were met during this inspection with a census of 4 staff supervising 17 children.
· A fully charged fire extinguisher (2A:10BC) was observed. A smoke detector and carbon monoxide detector were present and tested by the Licensee during this inspection.
· Appropriate supervision was provided during this inspection
· Classrooms are equipped with age-appropriate furniture and equipment in good condition
· Classrooms are clean and free of hazards
· All materials and surface accessible to children are toxic free.
· No weapons stored at the facility.
· There are no bodies of water present. All wading pools or similar product must be emptied immediately after use and stored in an upright position.
· Medications are stored where inaccessible to children in a locked cabinet next to the office.
· Center is equipped to isolate and care for any child who becomes ill during the day at the office and use staff restrooms.
· Hazards are stored where inaccessible to children which include disinfectants, cleaning solutions and other items that are dangerous to children.
· All classroom floors shall be clean and safe
· Measures are taken to keep the facility free of flies, other insects and rodents on a monthly basis.
· Toxins are locked.
· Bathrooms were observed to be safe, clean and in operating condition.
· Playgrounds are enclosed by appropriate fences and free of hazards.
· Outdoor activity areas are supplied with age and size appropriate equipment in good condition.
· Food preparation area is clean and free of vermin.
· Food is stored appropriately and protected from contamination.
· All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023

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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KINDERCARE LEARNING CENTER	FACILITY NUMBER: 364809076
	VISIT DATE: 06/13/2023

NARRATIVE

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· LPA Susan Brewer, was unable to verify if uncontaminated drinking water is readily available both indoors and outdoors. LPA observed disposable cups next to the sink, located in the school age classroom and confirmed that school age children access tap water for drinking, from a sink located in the classroom. To date, the facility has not provided proof of lead testing for water outlets used for consumption and/or food prep. Per director, some children bring their own individual water cups and staff can contact a kitchen staff to request filtered water in pitchers, however, LPA did not observe pitchers of water readily available for children in the classrooms on 06/13/2023.
· The areas around or under high climbing equipment, swings, slides, and similar equipment shall be cushioned with material that absorbs a fall by wood chips.
· Menus shall be posted at least one week in advance in a place visible by the child’s authorized representative, dated and kept on file for 30 days, and made available upon request.
· Sign in/Sign out record was reviewed and meets regulation requirements
· A Staff member is present with current Pediatric CPR/First Aid which expires on: 05/2025
· Opening and closing staff member’s CPR/First Aid expires on: 01/2024
· Director completed Health/Safety/Nutrition Training Fall 2018 transcripts; No Lead.
· Staff qualifications and files were reviewed – On 06/13/2023, a health screening is on file and all staff meet educational requirements and health requirements for performing assigned tasks.
· Staff received on the job training for housekeeping, sanitation and universal health precautions
· Each child’s file is complete on 06/13/2023.
· Licensee was informed of the Department has inspection authority per Health and Safety Codes
· Documentation of Lead Testing is on file: NOT ON FILE
· A review of staff records on 06/01/2023 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023

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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KINDERCARE LEARNING CENTER	FACILITY NUMBER: 364809076
	VISIT DATE: 06/13/2023

NARRATIVE

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For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm For FCCHs: Incidental Medical Services (IMS) policy was discussed.

Director Alisa Holtegaard, was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov for Riverside Regional Office.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Deficiency was cited for a Type B violation this visit.

Civil Penalties was not issued this visit.

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

Exit interview conducted and report was reviewed with the Director Alisa Holtegaard.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/13/2023 05:00 PM - It Cannot Be Edited

Created By: Susan Brewer On 06/13/2023 at 04:36 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: 364809076
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in the licensee failed to conduct required lead testing on water outlets used for water consumption and food preparation, prior to January 1, 2023; which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/07/2023
	Plan of Correction
1 2 3 4	The licensee agrees to have all facility water outlets used for consumption and food preparation, sampled and analyzed by a certified vendor for lead exposure; and send proof of scheduling along with the post testing results to the department by fax, mail or e-mail.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Kimberly Williams

LICENSING EVALUATOR NAME:

Susan Brewer

LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023

LIC809 (FAS) - (06/04)

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