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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483001826
Report Date: 07/23/2021
Date Signed: 07/23/2021 01:09:44 PM

Document Has Been Signed on 07/23/2021 01:09 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
483001826
ADMINISTRATOR:WENDY CERTEZAFACILITY TYPE:
840
ADDRESS:1101 ROSE DRIVETELEPHONE:
(707) 745-0916
CITY:BENICIASTATE: CAZIP CODE:
94510
CAPACITY: 48TOTAL ENROLLED CHILDREN: 0CENSUS: 12DATE:
07/23/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Erika RamirezTIME COMPLETED:
01:20 PM
NARRATIVE
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Licensing Program Analysts (LPAs), Melchisedeck Augustin and Elpidia Hernandez Torres made an unannounced Case Management visit and met with the Center Director, Erika Ramirez (CD) to deliver this report and citation. During the course of a complaint investigation, LPA Augustin obtained evidence showing that due to a shortage in staffing, there was an absence of supervision at the facility.

From 04/19/21 through 04/27/21, LPA interviewed one adult and three staff who reported that on several different occasions, they witnessed groups of children sitting alone without staff supervision in either the facility lobby and/or hallway, breakroom, or in the Center Director’s office. One statement noted children were seen waiting in the breakroom because the assigned teacher was not on shift yet and the staff responsible for those children’s supervision sometimes left the children alone because that staff had something else to do. Within that same timeline, the Department received corroborating evidence which confirmed and further supported claims of absence of supervision at the facility. Records showed that on several different occasions, one to three child(ren) either sat in the facility lobby near the bathroom, in the breakroom, or the Center Director’s office without supervision of staff.

Based on the evidence obtained through the course of the complaint investigation, the facility did not comply with supervision requirements as mandated by California Code of Regulations (CCR), 101229(a)(1), the following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Notice of Site Visit shall be posted for 30 days. Appeal Rights were provided.

Reports citing Type A violations are to be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE: DATE: 07/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/23/2021
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 07/23/2021 01:09 PM - It Cannot Be Edited


Created By: Melchisedeck Augustin On 07/23/2021 at 07:38 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
, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 483001826

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/23/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/24/2021
Section Cited
CCR
101229(a)(1)

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No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
This requirement is not met as evidenced by: Based on
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Director stated she hired new staff who are qualified and the qualified staff will immediately go to their assigned classroom. The administration team will now conduct 15 minute checks in the classrooms to ensure that supervision requirements are being met. The Director will produce and submit a written
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evidence obtained through the course of a complaint investigation, showed that the facility did not comply with supervision requirements as mandated by California Code of Regulations (CCR), 101229(a)(1). This posed an immediate health and safety risk to the children in care.
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statement to inform the Department of how she intends to comply with supervision requirements by 07/24/21 via mail, email or fax.

email: melchisedeck.augustin@dss.ca.gov
public email: cclrpregionalofficegeneral@dss.ca.gov
Fax: 707-588-5099

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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:Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:
DATE: 07/23/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/23/2021


LIC809 (FAS) - (06/04)
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