<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364818108
Report Date: 01/06/2023
Date Signed: 01/06/2023 02:39:52 PM

Document Has Been Signed on 01/06/2023 02:39 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:
364818108
ADMINISTRATOR:EMILY CALHOUNFACILITY TYPE:
830
ADDRESS:33788 YUCAIPA BLVD.TELEPHONE:
(909) 797-4713
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY: 24TOTAL ENROLLED CHILDREN: 25CENSUS: 18DATE:
01/06/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Assistant Director Ruth DeAndaTIME COMPLETED:
02:45 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 01/06/2023 at 1:00 PM, Licensing Program Analysts (LPAS) Susan Brewer and Rachel Zeron arrived unannounced, to conduct case management visit in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 12/22/2022. LPAs were greeted by Assistant Director (AD) Ruth DeAnda, and granted entry to tour the facility inside and out. Director Emily Calhoun was not present. A census was taken. A separate report is also documented today for a complaint received on 12/28/2022, CONTROL NUMBER: 09-CC-20221228165336, linked to the self reported incident.

It was reported that on 12/22/2022 at 10:30 AM, the agency staff were transitioning 8 day care children to the playground for outdoor activity and Staff 1 (S1 identified on confidential names list) conducted a headcount noticing that there were only 7 children transitioned to the playground, with day care Child 1 (C1 identified on confidential names list) missing. LPAs reviewed facility records, conducted interviews with pertinent parties present at the time of the incident. In addition, the agency was unable to produce documentation that C1's authorized representative received notification of the incident that took place on 12/22/2022. According to the Agency's Published Family Handbook, the 2nd Paragraph Heading for Communication on Page 34 (listed as the 6th bullet), indicates that the agency will promote close communication through: Daily happenings... (Text in part: very young children receive individualized daily reports called "Family Communication" forms each day of attendance). Based on the information gathered, the following violations have been identified. The agency failed to inform the authorized representative of the C1, regarding the incident that took place on 12/22/2022, where C1 was left unattended in the infant classroom for an undisclosed time frame. It was also determined that an incident report was created, however, by admission, the Assistant Director Ruth DeAnda, acknowledged that the authorized representative for C1, was not provided a copy of the report, nor was a copy of the incident report placed in C1's file, which is a potential risk to the health and safety of children in care. See LIC809D for cited deficiencies of the California Code of Regulations, Title 22, Div. 12. An exit interview was conducted, appeal rights discussed, and a copy of this report was provided to facility Administrative Director Ruth DeAnda.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 01/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 01/06/2023 02:39 PM - It Cannot Be Edited


Created By: Susan Brewer On 01/06/2023 at 01:08 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: 364818108

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/16/2023
Section Cited
CCR
101219(f)

1
2
3
4
5
6
7
101219 Admission Agreement
(f) The licensee shall comply with all terms and conditions set forth in the admission agreement.
This regulation was not met as evidenced by:
Based on records gathered and admission of the agency representative Ruth DeAnda, the
1
2
3
4
5
6
7
the agency Assistant Director Ruth DeAnda agrees to write a written understanding of the regulation regarding admission agreement set forth between the agency, to their clients and staff at the facility on or before 01/16/2022. Proof of the written understanding can be submitted by fax, mail or e-mail.
8
9
10
11
12
13
14
agency acknowledged that they did not follow admission agreement for the authorized representative/parent for a daycare child, and failed to provide an incident report regarding incident on 12/22/2022, which is a potential risk to the health & safety of children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 01/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/06/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2