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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483001825
Report Date: 01/09/2026
Date Signed: 01/09/2026 02:27:03 PM

Document Has Been Signed on 01/09/2026 02:27 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:		MICHELLE PALACIOSFACILITY TYPE:
850
ADDRESS:1101 ROSE DRIVETELEPHONE:
(707) 745-0916
CITY:BENICIASTATE: CAZIP CODE:
94510
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 42DATE:
01/09/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:28 AM
MET WITH:Michelle PalaciosTIME VISIT/
INSPECTION COMPLETED:
02:35 PM
NARRATIVE
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On 01/09/2026, Licensing Program Analyst (LPA), Selena Mariani made an unannounced Case Management visit in response to a self-reported Unusual Incident Report (UIR). The UIR was notified to Community Care Licensing on 12/17/2025. The incident was regarding a child being left unsupervised in facility hallway during a classroom to classroom transition. LPA met with Center Director (CD) Michelle Palacios and spoke with her about the purpose of today's visit.

During today's inspection, LPA toured the inside and outside of the facility. LPA received written statements from 5 staff (S1-S5), in-person interview with CD and 2 staff (S2 & S3), phone interview with 1 parent (P1) and attempted interview with 1 child (C1). CD stated that on 12/23/25 she conducted in-person training on transitions with all preschool teachers and all transitions will be supervised by management. S1 stated at 4:25 pm the classroom transition of 4 children began and five minutes later S3 was asking over the walkie about the classroom to classroom transition. S2 stated at 4:25 pm, the 4 children began classroom to classroom transition, at 4:30 pm, S3 brought C1 to the classroom and asked why C1 was in the hallway alone. S2 stated I forgot it was 4 kids not 3 (transitioning). S3 stated at 4:25 pm there was no child in the hallway, but at 4:30 pm sees C1 in the hallway at the classroom door alone. S5 stated being in S3's classroom at 4:25 pm for several minutes, while walking down the hall sent a text at 4:29 pm and did not see any child left unattended at that time. S2 stated in the in-person interview that when S3 brought C1 to the classroom C1 was calm and didn't know how C1 was left in the hallway. S3 stated in the in-person interview that C1 was standing at the (hallway) door looking in. S3 further stated, I opened the door and asked C1 what they was doing out there. C1 replied, I don't know. S3 stated C1 wasn't crying and C1's parent was verbally told of the incident at pick up. No one was in the office and no one was in the hallway when S3 saw C1 at my door. Continue on LIC809-C
NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin
NAME OF LICENSING PROGRAM ANALYST: Selena Mariani
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 01/09/2026 02:27 PM - It Cannot Be Edited


Created By: Selena Mariani On 01/09/2026 at 11:55 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
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 483001825

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/12/2026
Section Cited
CCR
101229(a)(1)

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101229 (a)(1) The licensee shall provide care and supervision as necessary to meet the children’s needs. No child(ren) shall be left without the supervision of a teacher at any time.... Supervision shall include visual observation.
This requirement is not met as evidenced by:
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CD stated on 12/23/25, preschool teachers were trained on transitioning children and will provide LPA a summary of training with date, staff name printed and signatures of staff that attended. CD will email LPA document to selena.mariani@dss.ca.gov by end of buisness day, Monday, 01/12/26
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Based on the facility's self reported UIR, S2-S3 interviews, S2, S3 & S5 written statements and documents received a child was left without supervision in the facility hallway during a transition from one preschool classroom to another for approximately 1-5 minutes. This poses an immediate health and safety risk to 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.
Melchisedeck Augustin
NAME OF LICENSING PROGRAM MANAGER:
Selena Mariani
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2026


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: 01/09/2026
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Continue from LIC809
P1 stated being informed of the incident at pick up, furthermore, the classroom where C1 was found is at the end of the hall, which makes me worried because C1 could have went out the back door into the outside play yard. LPA observed the outdoor play yard to be fully fenced.

Based on CD's self reported written unusual incident report (UIR) of the 12/16/25 incident, S2-S3 written statements and in-person interviews and S5 written statement confirm that a child was left without supervision in the facility hallway for approximately one to five minutes when transferring four children from one classroom to another.

California Code of Regulations, Title 22, is being cited on the attached LIC 809-D. Appeal rights were provided. An exit interview was conducted, and this report was read and discussed with the Center Director Michelle Palacios. The Notice of Site Visit shall be posted for 30 days.

Reports citing Type A violations are to be provided to parents/guardians of children currently enrolled by the next business day or the next day the children are in care, and to parents/guardians of children newly enrolled at the facility for the next 12 months from the date of this report. Parents/guardians must sign Form LIC 9224 to be kept in each child's file.

NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin
NAME OF LICENSING PROGRAM ANALYST: Selena Mariani
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2026
LIC809 (FAS) - (06/04)
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