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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483001825
Report Date: 11/06/2024
Date Signed: 11/06/2024 04:35:00 PM

Document Has Been Signed on 11/06/2024 04:35 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
483001825
ADMINISTRATOR/
DIRECTOR:		ERIKA SILVAFACILITY TYPE:
850
ADDRESS:1101 ROSE DRIVETELEPHONE:
(707) 745-0916
CITY:BENICIASTATE: CAZIP CODE:
94510
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 59DATE:
11/06/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:38 AM
MET WITH:Erika SilvaTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
NARRATIVE
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An unannounced case management visit was made to the facility by Licensing Program Analyst (LPA) Selena Mariani in response to a self-reported, lack of supervision incident involving Child 1 (C1) that occurred on 10/25/2024. It was reported that a child left the building for roughly 1-2 minutes. During today's visit LPA met with Director (D1) Erika Silva to discuss the incident. LPA also conducted observation, staff interviews with Director (D1), 3 staff (S1-S3), attempted interview with a child and obtained documents.

Staff interviews revealed on 10/25/2024 at approximately 5:39 pm, C1 left the premises for 1 or 2 minutes and was found by an individual on the sidewalk next to the street. Interviews revealed C1 was in Discovery Preschool B classroom (DPB), opened the adjoining door to a vacant Discovery Preschool A classroom (DPA), went into the hallway and out the front door. The individual found C1 roughly 1 to 2 minutes later. Staff 3 (S3) stated they saw the individual bring C1 in from outside as they were leaving. The individual stated they were nervous for C1's safety on the sidewalk near the street. Staff 1 (S1) stated they realized C1 was missing during name to face check and Staff 2 (S2) stated they saw C1 open the door to DPB, but was attending to another child and asked S1 to get C1. Staff interviews had contradictory information. D1 stated C1 had previously attempted elopements. D1 stated that C1 was found on the sidewalk next to the road. LPA observed the sidewalk is on a busy street next to the building. D1 stated that this incident was reported to the child's authorized representatives and a gate has been installed between the front door and the hallway. Based on interviews, it has been determined C1 was unattended outside for roughly 1-2 minutes on 10/25/2024.

Continued on LIC809-C

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Selena Mariani
LICENSING EVALUATOR SIGNATURE: DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2024
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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 483001825
VISIT DATE: 11/06/2024
NARRATIVE
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Continue from LIC809

An immediate $500 civil penalty is being assessed today for absence of supervision. This report was reviewed and discussed with Director Erika Silva. Notice of Site Visit shall be posted for 30 days from today's visit. The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.

LPA Selena Mariani informed Director Erika Silva that this report dated 11/06/2024 documents one Type A citation. Type A citations shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Selena Mariani informed the Director Erika Silva to provide a copy of this licensing report dated 11/06/2024 that documents any Type A citation 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 verification.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Selena Mariani
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/06/2024 04:35 PM - It Cannot Be Edited


Created By: Selena Mariani On 11/06/2024 at 01:49 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
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 483001825

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/07/2024
Section Cited
HSC
1596.99(c)(3)

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The department shall assess an immediate civil penalty of $500 per violation and $100 for each day the violation continues after citation, for any of the following serious violations: Absence of supervision, including, but not limited to, a child left unattended, and supervision of a child by a person under 18 years of age.
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D1 will provied email proof of alarm installation for ajoining doors and new Fire Marshall approved locking mechanism for front doors. LPA gave D1 the 'Active Supervision' and 'Active Supervision Toolkit' handouts. D1 stated she will go over the handouts with staff at the next staff meeting.
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This requirement has not been met as evidenced by: On 10/25/2024, C1 left the premises for roughly 1-2 minutes resulting in an absence of supervision, which poses an immediate Health and Safety risk to children in care.
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D1 stated and LPA observed facility installed a gate in the hallway near the front door on 11/6/24. D1 will email LPA proof of door alarm, front door locking mechanism and Active Supervision attenance sheets by 11/27/24 to email selena.mariani@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:Leslie Lepori
LICENSING EVALUATOR NAME:Selena Mariani
LICENSING EVALUATOR SIGNATURE:
DATE: 11/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/06/2024


LIC809 (FAS) - (06/04)
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