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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483001827
Report Date: 08/02/2021
Date Signed: 08/02/2021 01:21:37 PM

Document Has Been Signed on 08/02/2021 01:21 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
483001827
ADMINISTRATOR:HAYMER, MORNENFACILITY TYPE:
830
ADDRESS:581 PEABODY ROADTELEPHONE:
(707) 447-7685
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY: 20TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
08/02/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Director, Mornen HaymerTIME COMPLETED:
01:30 PM
NARRATIVE
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On 8/02/2021 at 11:15am an annual inspection was made to the facility by Licensing Program Analyst (LPA), Kirk Marks and met with Director, Mornen Haymer. The facility file was reviewed prior to this inspection. A review of the personnel report on 8/02/21 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The facility’s operating hours are 6:30am to 6:00pm, Mon-Fri. The facility was toured at 11:25 inside and outside and the floor and yard plan submitted by the licensee were verified.

The Director stated no firearms or weapons are stored on site and none were observed. There are no pools or similar bodies of water. The items which could pose a danger to children (such as disinfectants, cleaning solutions and medications) are inaccessible to children. Poisons are not stored at the facility. Furniture and equipment are in good condition and free of hazards. The outdoor activity space was cushioned with rubberized padding and free of hazards. Toilets and sinks are in sanitary condition and operating properly. The facility floors were clean and safe. The kitchen/food preparation area is clean, and free of litter or rodents. Food is properly stored and free of contamination. Trash cans have tight fitting lids. Drinking water is available to children both inside and outside. The facility was free of flies, insects and rodents. The facility has a working carbon monoxide detector.

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SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Kirk Marks
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 483001827
VISIT DATE: 08/02/2021
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(continued from page 1)

During today's inspection, staffing ratios were being met and there were nine children being supervised by three teachers/aides. Children are not left without visual supervision at any time. The facility was operating within the licensed capacity. At least one staff member present during the visit (S1) possessed current CPR and First Aid certifications. The sign in/out sheet was reviewed, and representatives are using full signatures and recording the time. Staff are provided on-the-job training, including sanitation and universal precautions. Children with symptoms of illness are not accepted, and children who become ill during the day are isolated in front office. A weekly menu was posted online for all parents.

Nine children’s records were reviewed at 11:45, and contained emergency identification forms. Three staff records were reviewed at 12:30pm, and contained proof of mandated reporter training, and proof of immunizations.

All licensing reports are public information and must be made available upon request for at least three years.

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.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Kirk Marks
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/02/2021 01:21 PM - It Cannot Be Edited


Created By: Kirk Marks On 08/02/2021 at 12:57 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
, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 483001827

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/02/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/16/2021
Section Cited
CCR
101221(b)(8)

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Child’s Records. The child’s record shall contain their medical assessment including physicians report.
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The facility director agrees to provide proof of receipt of physicians reports for the children's missing files by 8/16/2021.
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This requirement was not met as evidenced by: based on records review, children 7-9 were without physicians reports. This could pose a potential 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.
SUPERVISOR'S NAME:Megan Aviles
LICENSING EVALUATOR NAME:Kirk Marks
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2021


LIC809 (FAS) - (06/04)
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