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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393603299
Report Date: 10/19/2022
Date Signed: 10/19/2022 01:48:39 PM

Document Has Been Signed on 10/19/2022 01:48 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:KINDERCARE LEARNING CENTER - GRANTLINE (PRESCHOOL)FACILITY NUMBER:
393603299
ADMINISTRATOR:EVA PRADOFACILITY TYPE:
850
ADDRESS:265 W. GRANTLINE ROADTELEPHONE:
(209) 835-9247
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 56DATE:
10/19/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:31 PM
MET WITH:Eva Prado TIME COMPLETED:
02:30 PM
NARRATIVE
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On October 19, 2022 , Licensing Program Analyst (LPA) Stacey Williams arrived at the facility for the purpose of conducting a case management inspection. LPA met with Facility Representative. LPA observed four classrooms with fifty six ( 56) children (napping ) supervised by four staff.

Community Care Licensing( CCL) was notified on September 7, 2022 that Child #1 (C1) experienced an allergic reaction from ingesting a documented food allergy while at the childcare facility. C1 required medical attention from the outbreak. The facility did not submit an unusual incident report to CCL detailing the incident.

Title 22 deficiencies will be cited on subsequent page, LIC 809D.

Exit interview conducted at which time the report was reviewed with Facility Representative Eva Prado. A Notice of Site Visit was posted by LPA Williams and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2022
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 10/19/2022 01:48 PM - It Cannot Be Edited


Created By: Stacey Williams On 10/19/2022 at 11:30 AM
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
, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: KINDERCARE LEARNING CENTER - GRANTLINE (PRESCHOOL)
FACILITY NUMBER: 393603299

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/18/2022
Section Cited
CCR
101212(d)(1)(B)

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Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.
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Facility Director will train management on reporting incidents to Community Care Licensing. Training roster and documents will be emailed to CCL by POC date- 11/18/22.
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(B) Any injury to any child that requires medical treatment.
This requirement was not met as evidenced by: C1 required medical attention after ingesting a food item at the facility and experiencing an allergic reaction.This incident was not reported to CCL. This poses a potential risk to the health and safety 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:Bettina Engelman
LICENSING EVALUATOR NAME:Stacey Williams
LICENSING EVALUATOR SIGNATURE:
DATE: 10/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2022


LIC809 (FAS) - (06/04)
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