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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483001827
Report Date: 09/11/2024
Date Signed: 09/11/2024 04:24:52 PM

Document Has Been Signed on 09/11/2024 04:24 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
483001827
ADMINISTRATOR/
DIRECTOR:		HAYMER, MORNENFACILITY TYPE:
830
ADDRESS:581 PEABODY ROADTELEPHONE:
(707) 447-7685
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY: 20TOTAL ENROLLED CHILDREN: 18CENSUS: 16DATE:
09/11/2024
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:05 AM
MET WITH:Brenda Hardaway - Center DirectorTIME VISIT/
INSPECTION COMPLETED:
04:40 PM
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An Annual/Required inspection was made to the facility by Licensing Program Analyst (LPA), Melchisedeck Augustin. The facility file was reviewed prior to this visit. A review of the personnel report on file indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Facility Representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. The facility did not operate under Title 5 regulations and there are no active/standing waiver(s). This facility was approved to provide child care services to military families.


There were two teachers, and four Aides were supervising sixteen children in Infant and Toddler classrooms. Operating hours are 6:30am - 6:00pm, Mon-Fri. The license, Earthquake Preparedness Checklist, Parent Rights, Personal Rights, Emergency Disaster Plan, California Child Passenger Safety Law flyer which included the local public health contact were posted on a parent board at the lobby. During today's inspection, infant staffing ratios were being met and children were being directly supervised by staff, and the facility was operating within the licensed capacity. The facility was toured inside and outside, and the floor and yard plan were verified. Activity space for infants was separate from other age groups. The items which could pose a danger to children (detergents and cleaning compounds) were inaccessible to children.

LPA did not observe any poison(s) and according to the Facility Representative, there were no firearm(s) or other dangerous weapon(s) stored on the premise. The facility was free of flies, insects, and rodents. The toys, floors, and other equipment and surfaces appeared clean, toxic free, safe for infants and in good condition. (Continue to LIC 809-C)

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE: DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2024
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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 483001827
VISIT DATE: 09/11/2024
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There is drinking water available to children both indoors and outdoors. Each child had a sippy cup filled with water for them to drink on the playground. The infant changing tables had raised sides that were at least three inches high and had padded surface that were no less than one inch thick and covered with washable vinyl or plastic; and there was a sink within an arm’s reach. There were one hand washing sink to every 15 infants. There is sufficient napping equipment (cribs and cots) available that met the infant sleeping requirements. The facility was equipped with appropriate furniture and equipment including changing tables; and feeding chairs; that were well maintained.

The facility met the requirements of Infant Care Food Services and bottles were properly stored and refrigerated as needed. The playground was free of hazards. The playground equipment and surface areas appeared in safe condition. There was foam cushioning underneath the high climbing structure to absorb falls.

The Vacaville Fire Department granted the facility a fire clearance to operate at a capacity of 20. There was at least one working carbon monoxide detector in each classroom, and functional fire alarm, and a full charged fire extinguisher rated at least 2A10BC. There were no bodies of water observed. The Facility Representative possessed current Emergency Medical Services Authority (EMSA) approved Cardiopulmonary Resuscitation (CPR) and First Aid certification which expired on 04/22/2025. The facility conducted an emergency disaster drill within six months and the last drill was documented on 06/04/2024. The Facility Roster of the children currently in care was reviewed and appeared to be complete. A review of the children’s sign in/out procedure revealed that several parents had not signed their child(ren) in and out.

Eight staff (S1-S7 & CD) records were reviewed at 11:14am which reflected S7’s Tuberculosis (TB) clearance/result was not within 12 months of hire and S7 was missing proof of immunity against Measles and evidence of completion for AB 1207 Mandated Reporter Training. Five children’s (C1-C5) records were reviewed at 11:55am which revealed C1 was missing Licensing forms: 627, 701, 702, 995, Immunization Record (IR) and IR was not transcribed onto blue CDPH 286, and Admission Agreement was no signed. C2-C3’s IRs were transcribed onto incorrect public health form (CDPH 286), and C4’s Admission Agreement was not signed by the parent. Furthermore, several children including C2-C5's Infant Needs and Services Plan had not been updated quarterly. The facility furnished evidence to prove 15 minute checks were conducted while infants took a nap. (Continue to LIC 809-C)

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024
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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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 483001827
VISIT DATE: 09/11/2024
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.



Facility Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

LPAs discussed the safe sleep regulations with Facility Representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.


(Continue to LIC 809-C)

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024
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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 483001827
VISIT DATE: 09/11/2024
NARRATIVE
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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.


The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Facility Representative, Brenda Hardaway. Appeal Rights were provided.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/11/2024 04:24 PM - It Cannot Be Edited


Created By: Melchisedeck Augustin On 09/11/2024 at 01:50 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: 483001827

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/11/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on eight staff (S1-S7 & CD) records reviewed at 11:14am which revealed S7 was missing proof of immunity against Measles. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/25/2024
Plan of Correction
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Director said she would notify S7 of the missing Immunization and ensure S7 obtain evidence of required immunization, and Director intends to submit evidence of S7's immunization to the department by 09/25/24. Email: melchisedeck.augustin@dss.ca.gov
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on eight staff (S1-S7 & CD) records reviewed at 11:14am which revealed S7's Tuberculosis (TB) clearance was more than one year of the hire date. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/25/2024
Plan of Correction
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Director said she would notify and ensure S7 obtained evidence of negative TB clearance that meets the requirements, and Director intends to submit evidence of S7's clearance to the department by 09/25/24. Email: melchisedeck.augustin@dss.ca.gov& Fax: 707-588-5099
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: 09/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/11/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/11/2024 04:24 PM - It Cannot Be Edited


Created By: Melchisedeck Augustin On 09/11/2024 at 01:50 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: 483001827

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/11/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101221(b)(6)
Child's Records
(b) Each record shall contain information including, but not limited to, the following: (6) A signed copy of the admission agreement specified in Section 101219.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on five children's (C1-C5) records reviewed at 11:55am which revealed C1 & C4's Admission Agreements were not signed by the children's parents. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/25/2024
Plan of Correction
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Director said she would review children's records to ensure all Admission Agreements were signed by the children's parents, and Director intends to submit evidence of C1 & C4's signed documents to the department by 09/25/24. Email: melchisedeck.augustin@dss.ca.gov
Type B
Section Cited
CCR
101221(b)(8)(C)
Child's Records
(b) Each record shall contain information including, but not limited to, the following: (8) Medical assessment, including ambulatory status as specified in Section 101220, and the following health information: (C) A signed consent form for emergency medical treatment unless the child's authorized
representative has signed the statement specified in Section 101220(f).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on five children's (C1-C5) records reviewed at 11:55am which revealed C1 was missing LIC 627. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/25/2024
Plan of Correction
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Director said she would provide C1's parent with LIC 627m obtain the parent's signature on the form, and provide evidence of the signed form to the department by 09/25.24. Email: melchisedeck.augustin@dss.ca.gov
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: 09/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/11/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/11/2024 04:24 PM - It Cannot Be Edited


Created By: Melchisedeck Augustin On 09/11/2024 at 01:50 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: 483001827

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/11/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101419.3(a)
Modifications to Infant Needs and Services Plan
(a) The written infant needs and services plan shall be updated at least quarterly, or as often as necessary to assure its accuracy.

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
4
Based on LPA's observations of several children's including C2-C5's Infant Needs and Services Plan had not been updated quarterly. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/25/2024
Plan of Correction
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Director said she would review all Infant Needs and Services Plans, work with parents to update the plans, and submit evidence of all updated Infant Needs & Services Plans to the department by 09/25/24. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099
Type B
Section Cited
CCR
101220(a)
Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on five children's (C1-C5) records reviewed at 11:55am which revealed C1 was missing LIC 701. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/25/2024
Plan of Correction
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Director said she would notify C1's parent of the missing medical assessment, obtain the completed form and submit evidence of the completed form to the department by 09/25/24. Email: melchisedeck.augustin@dss.ca.gov
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: 09/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/11/2024


LIC809 (FAS) - (06/04)
Page: 7 of 8
Document Has Been Signed on 09/11/2024 04:24 PM - It Cannot Be Edited


Created By: Melchisedeck Augustin On 09/11/2024 at 01:50 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: 483001827

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/11/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101229.1(a)(1)
Sign In and Sign Out
(a) In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum, include the following: (1) The person who signs the child in/out shall use his/her full legal signature and shall record the time of day.

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
4
Based on LPA's review of the children's sign in/out procedure which revealed that several children had not been signed in and out. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/25/2024
Plan of Correction
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Director said she would talk with staff and parents about signing in and out, and Director intends to review the procedure to ensure that parents are signing their child in and out, and Director intends to submit evidence to prove the procedure is being follow by 09/25/24.
Section Cited
Deficient Practice Statement
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2
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POC Due Date:
Plan of Correction
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4
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: 09/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/11/2024


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