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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364818108
Report Date: 12/05/2023
Date Signed: 12/05/2023 01:53:43 PM

Document Has Been Signed on 12/05/2023 01:53 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: 24CENSUS: 20DATE:
12/05/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Alisa Holtegaard, Interim DirectorTIME COMPLETED:
02:00 PM
NARRATIVE
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On December 5, 2023, Licensing Program Analysts (LPAs) Raymond Moorehead & Elyse Jones arrived at the facility to conduct a Case Management inspection for the purpose of addressing separate matters that were discovered during an inspection at the facility. During the inspection LPAs conducted a tour of the facility and census was taken. LPAs reviewed and obtained records, conducted interviews with pertinent parties.

During today’s interviews it was disclosed that a child has chronic biting behavior. It was disclosed that the child would bite other children daily while in care. LPAs reviewed documentation which revealed that between July-November of 2023 there were at least 13 incidents involving this child since enrollment. Authorized Representatives were informed by the former director that if the facility paused services or disenrolled the child, the child would need to return with a Behavioral Aide. In August of 2023, the Authorized Representative voluntarily paused services. In October of 2023, the child returned to the facility without a Behavioral Aide and the biting continued, resulting in eight additional bites since returning. Although most of the bites generated an Incident/Accident Report, which were signed by the staff in charge and the Parent/Guardian, Interim Director could not locate the Incident/Accident Report binder at the time of today's inspection. At this time, nothing substantial was implemented, in order to curve the biting or to ensure that all children’s Personal Rights are not being violated. Staff have offered a teether, redirection, shadowing and keeping the child close to Staff but none of the measures taken have been effective.

See LIC 9099-D for the deficiencies cited.

LIC 9224/Type A citation must be provided to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for the verification.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Raymond Moorehead
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2023
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: 364818108
VISIT DATE: 12/05/2023
NARRATIVE
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A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
Exit interview conducted and report was reviewed with Alisa Holtegaard, Interim Director.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Raymond Moorehead
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/05/2023 01:53 PM - It Cannot Be Edited


Created By: Raymond Moorehead On 12/05/2023 at 01:22 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: 12/05/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/06/2023
Section Cited
CCR
101223(a)(2)

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101223 (a)(2) - Personal Rights
Each child shall be accorded safe, healthful, and comfortable accommodations, furnishings, and equipment.This requirement was not met as evidenced by: Based on the interview and record review, the Licensee did not meet the Personal Rights
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Interim Director agrees to read Personal Rights regulation and write a statement of understanding. Director also agrees to write a plan that details what steps the facility will take to prevent further biting. Interim Director agrees to provide Authorized Representative with supplemental Behavior Policy.
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regulation which poses an immediate Personal Rights risk to the children in care. There were at least 13 incidents documented involving a child being bitten, scratched and/or hit. The Interim Director confirmed the incidents reported did occur while in care.
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The written statement and plan are due on 12/06/2023. Behavior Policy will be due within 24 hours of having a discussion with Authorized Representative. Interim Director agrees to submit plan of correction to LPA via email at Raymond.Moorehead@dss.ca.gov

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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:Aaron Ross
LICENSING EVALUATOR NAME:Raymond Moorehead
LICENSING EVALUATOR SIGNATURE:
DATE: 12/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2023


LIC809 (FAS) - (06/04)
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