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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364809077
Report Date: 06/06/2023
Date Signed: 06/06/2023 07:00:49 PM

Document Has Been Signed on 06/06/2023 07:00 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 CENTERFACILITY NUMBER:
364809077
ADMINISTRATOR:ALISA HOLTEGARRDFACILITY TYPE:
830
ADDRESS:960 W. BLOOMINGTONTELEPHONE:
(909) 877-3399
CITY:BLOOMINGTONSTATE: CAZIP CODE:
92316
CAPACITY: 23TOTAL ENROLLED CHILDREN: 23CENSUS: 20DATE:
06/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Assistant Director Melissa Speakman and Director Alisa HoltegaardTIME COMPLETED:
04:30 PM
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On 06/06/2023 at 9:40 am Licensing Program Analyst (LPA) Susan Brewer arrived at the facility to conduct a 1 year required annual inspection. LPA was granted entry by Assistant Director Melissa Speakman. LPA toured the facility, inside and out, reviewed records, and observed and/or discussed the following: Director Alisa Holtegaard, joined the inspection at 10:00 AM.

Normal days and hours of operation: Monday- Friday, 6:00 AM to 6:00 PM

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 and
Personal Rights. The inspection found the facility to be in compliance in these domains, except as noted on the LIC809-D.

The licensee is asked to update the following documents, if applicable, and submit to licensing within 30 days 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

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.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2023
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: 364809077
VISIT DATE: 06/06/2023
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· The facility is operating within the terms of the license.
· Facility is clean, safe and sanitary and in good repair.
· Appropriate supervision and Ratios were met during this inspection: 5 staff supervising 20 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.
· Rooms and activity areas are physically separated from other component.
· Rooms are equipped with age-appropriate furniture and equipment in good condition.
· Uncontaminated drinking water is provided in both the indoor and outdoor activity areas by public water supply and filtered water and individual sippy cups.
· Napping equipment is sufficient for capacity and meets licensing requirements.
· Rooms are clean and free of hazards
· Materials and surfaces accessible to children are toxic free
· No weapons stored at the facility on 06/06/2023.
· 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 infants: Located in a locked drawer, next to the office.
· Center is equipped to isolate and care for any child who becomes ill during the day. Isolation room is in the Director’s Office and the staff restroom next to the office will be used as an isolation restroom. Staff will sanitize the restroom after each use.
· Toxins are locked and Hazards are stored where inaccessible to infants.
· In lieu of a toileting area, the LPA observed 2 changing tables and sinks, to be safe, sanitary and in operating condition.
· Outdoor play area is physically separated by appropriate fencing and free of hazards.
· Outdoor activity areas are supplied with age and size appropriate equipment in good condition
· There is sufficient cushioning material under high climbing equipment, swings, slides and similar equipment:
· Measures are taken to keep the facility free of flies, other insects, and rodents with monthly service.
· Food preparation area is observed by LPA to be clean and free of vermin.
· Food is stored appropriately and protected from contamination in the kitchen pantry.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023
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: 364809077
VISIT DATE: 06/06/2023
NARRATIVE
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· All storage containers for solid waste have tight-fitting covers that are kept on, and in good repair.
· Individual feeding and Infant needs and service plans were reviewed and are complete for each individual infant.
· Infants up to 12 months shall have a sleeping plan as required, however no sleep logs were completed to documentation of date, name, time of 15-minute check and staff initials for any of the children. The facility logged a naptime from start to finish for some children present.
· Infant files were reviewed and are NOT complete. 1 of 4 children’s files reviewed did not have a LIC701 Physicians Report. LPA reviewed Kindercare app to verify sleep logs for children enrolled, which only document the napping start times and wake up times. The director was unable to provide proof of 15 minute checks documented by staff for infant and toddlers present, enrolled and supervised at the facility.
· 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 01/2024
· Opening and closing staff member’s CPR/First Aid expires on 07/09/2024
· Director completed Health and Safety Training in the Fall 2018, No nutrition or Lead
· Staff qualifications and files were reviewed and are NOT complete. 1 staff file was missing mandated reporter training part 1 and 2 certificates, their immunization records and health screening. A second staff file reviewed revealed the staff member's AB1207 certificate expired in 04/2023.
· Staff have received on the job training for housekeeping, sanitation, and universal health precautions
· Documentation of fire & earthquake drills to be conducted every six months: Last drill on 05/12/2023 at 9:45 AM, lasted 6 minutes.
· 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, Licensee was informed of the Department has inspection authority per Health and Safety Codes.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023
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: 364809077
VISIT DATE: 06/06/2023
NARRATIVE
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AB2370 – Lead Exposure, day care facilities, effective January 1, 2019 –
The bill requires that all Child Care Centers, operating in a building constructed before January 1, 2010, shall have their drinking water tested for excessive lead levels, on or after January 1, 2020, but no later than January 1, 2023. Child Care Centers must thereafter test their drinking water every five years after the date of the initial test.
AB605 – Child day care facilities, birth to school-age license; Effective January 1, 2021
AB2960 – Child care and development services, online portal – Effective June 20, 2022 - This bill requires the State Superintendent of Public Instruction (SSPI), within the California Department of Education (CDE), to develop and post on CDE's website a comprehensive child care and development services online portal for families and providers by June 30, 2022.
Please subscribe at www.childcareadvocatesprogram to receive Department updates. They will be sent directly to your e-mail account once you have set up an account.
Duty Officer is available to answer questions Mon. – Fri. at 1-844-LET-US-NO (1-844-538-8766).

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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 CCCs: Incidental Medical Services (IMS) policy was discussed

Facility representative 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.

LPA Susan Brewer, discussed the safe sleep regulations with Director Alisa Holtegaard and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023
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: 364809077
VISIT DATE: 06/06/2023
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LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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.

Deficiencies cited for Type B violations this visit

A civil penalty was not cited 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: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/06/2023 07:00 PM - It Cannot Be Edited


Created By: Susan Brewer On 06/06/2023 at 04:05 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: 364809077

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in 1 staff present and working in the infant center did not have documentation of required immunizations on file and has been working since February 2023, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/30/2023
Plan of Correction
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The licensee agrees to provide proof of immunization records for subject staff and submit to the department by fax, mail or e-mail. Per licensee the staff will not be present at the facility until proof of required immunizations are rec'd by the licensee.
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in a staff present and working at the facility did not complete a health screening for Tuberculosis, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/30/2023
Plan of Correction
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The licensee agrees to provide proof of a Tuberculosis screening for subject staff and submit to the department by fax, mail or e-mail. Per licensee the staff will not be present at the facility until proof of required documentation are rec'd by the licensee.
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: 06/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2023


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Document Has Been Signed on 03/08/2024 09:54 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 10/26/2023 07:05 AM


Created By: Susan Brewer On 06/06/2023 at 04:05 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 364809077

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(2)
Personnel Requirements
(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in the licensee failed to ensure that a subject staff present and working with children, complete a health screening prior to working with chidlren, which poses a potential health, safety or personal rights risk to persons in care. ***This is an amended statement***
POC Due Date: 06/30/2023
Plan of Correction
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The licensee agrees to provide proof of LIC503 Health Screening for a subject staff and submit to the department by fax, mail or e-mail. Per licensee the staff will not be present at the facility until proof of required health screening is rec'd by the licensee.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 1 subject staff member hired in 02/2023 did not complete the CA Child Abuse Mandated Reporter Training for Part 1 and Part 2, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/30/2023
Plan of Correction
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The licensee agrees to provide proof of Mandated Reporter Training Certificates for a subject staff and submit the certificates to the department by fax, mail or e-mail.
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: 06/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2023


LIC809 (FAS) - (06/04)
Page: 7 of 12
Document Has Been Signed on 06/06/2023 07:00 PM - It Cannot Be Edited


Created By: Susan Brewer On 06/06/2023 at 04:05 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: 364809077

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101220(a)
Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
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4
Based on record review, the licensee did not comply with the section cited above in 1 of 4 children's files reviewed did not have a LIC701 Physician's report which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/30/2023
Plan of Correction
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The licensee agrees to provide proof of physician's report for subject child and submit to the department by fax, mail or e-mail.
Type B
Section Cited
CCR
101429(a)(2)(C)
Responsibility for Providing Care and Supervision for Infants
(C) Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record record review, the licensee did not comply with the section cited above in the licensee failed to ensure sleep logs to document 15 minute checks were mained by supervising staff for each infant and toddler enrolled and supervised during naptime which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/08/2023
Plan of Correction
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The licensee agrees to provide proof of sleep logs for infant and toddler and ensure that staff understand how to complete the through training. The licensee will submit proof of training sign in sheet and subject matter discussed in the training regarding infant safe sleep and sleep logs, for participating staff assigned to supervise infants and toddlers. Documentation will be submitted to the department by fax, mail or e-mail.
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: 06/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2023


LIC809 (FAS) - (06/04)
Page: 8 of 12
Document Has Been Signed on 06/06/2023 07:00 PM - It Cannot Be Edited


Created By: Susan Brewer On 06/06/2023 at 04:39 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: 364809077

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
(a) (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
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2
3
4
The licensee was unable to provide proof of water sampling of outlets conducted prior to January 1, 2023, on facility outlets used to prepare food for consumption by children and staff at the facility, which poses a potential risk to the children in care.
POC Due Date: 07/06/2023
Plan of Correction
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2
3
4
The licensee agrees to provide proof of lead testing scheduled and proof of lead test analysis conducted by a certified vendor, on the water outlets used to provide water for consumption and food preparation.
Section Cited
Deficient Practice Statement
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2
3
4
POC Due Date:
Plan of Correction
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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: 06/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2023


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