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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364812754
Report Date: 10/12/2023
Date Signed: 10/12/2023 02:38:08 PM

Document Has Been Signed on 10/12/2023 02:38 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:
364812754
ADMINISTRATOR:ASHLEY RAWLSFACILITY TYPE:
850
ADDRESS:11249 BASELINE AVENUETELEPHONE:
(909) 581-0944
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY: 100TOTAL ENROLLED CHILDREN: 100CENSUS: 96DATE:
10/12/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:06 PM
MET WITH:Brenda Sandoval/assistant directorTIME COMPLETED:
03:15 PM
NARRATIVE
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On 10/12/23 at 2:06 pm, Licensing Program Analyst conducted a case management deficiencies investigation. LPA met with assistant director and was granted access into the facility. LPA toured facility and took a census.

During the course of an investigation, LPA was informed there was a child was left in wet shoes after a water day activity. LPA interviewed all pertinent parties. Pertinent parties confirmed a child was accidentally left in wet shoes after water play activity. Pertinent parties stated the child’s authorized representatives were informed of the child accidentally being left in wet shoes and were offered an apology.

See 809D for deficiency.

Exit interview conducted with director, report, appeal rights and notice of site visit issued.

Notice of site visit must be posted for 30 days.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023
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 10/12/2023 02:38 PM - It Cannot Be Edited


Created By: Patricia Berry On 10/12/2023 at 01:16 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: 364812754

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/19/2023
Section Cited
CCR
101223(a)(2)

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Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful, and comfortable accommodations, ..., and equipment to meet his/her needs.
This requirement was not met as evidenced by
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Assistant director stated she will conduct a training on personal rights regulation 101223 (a) (2) and send topic and a list of participants to CCL by 10/19/23.
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Based on pertinent parties confirmed a child was accidentally left in wet shoes after water play activity.

This is a potential risk to the Health and Safety and personal rights of children in care.
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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:Gilbert Sena
LICENSING EVALUATOR NAME:Patricia Berry
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2023


LIC809 (FAS) - (06/04)
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