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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483001838
Report Date: 06/23/2023
Date Signed: 06/23/2023 01:35:09 PM

Document Has Been Signed on 06/23/2023 01:35 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
483001838
ADMINISTRATOR:FIELDS, DONJEFACILITY TYPE:
850
ADDRESS:35 ROTARY WAYTELEPHONE:
(707) 557-3007
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY: 72; 72TOTAL ENROLLED CHILDREN: 62CENSUS: 39DATE:
06/23/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Justice Willis - Assistant Center DirectorTIME COMPLETED:
01:50 PM
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Licensing Program Analyst (LPA), Melchisedeck Augustin made an unannounced Plan of Correction (POC) visit and met with the Assistant Center Director, Justice Willis (AD) to follow up on and address an outstanding type B deficiency that was due by 06/17/2023. On 05/17/23, LPA conducted an inspection in response to water lead testing results received from the California State Water Resource Control Board. The test results showed that the following faucet tested above the allowable level (5.5 ppb) of lead in the water: Sample site, "A", is a sink located in the hallway outside the "Infant classroom", had a reading of 19.8 ppb and Sample site, “D”, is a hand washing station that is located in the “kitchen” had a reading of 6.3 ppb, and Sample site, “G”, is located in a preschool classroom; had a reading of 12.0 ppb. All other sources of water that were tested had a reading below the allowable level of 5.5ppb. On 12/06/22, the facility submitted the External Water Sampling Self-Certification Form (LIC 9275), Child Care Center Sampling Checklist Form (LIC 9276) and Facility Sketch/Floor Plan (LIC 999) to the Department.


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 childcare 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).

During today's inspection, AD did not furnish a POC and according to AD, she generated a work order to request remediation for sample sites, "A, D & G", however; AD did not receive a response from her superiors; and no steps or actions were taken to remediate sample site with lead exceedance. AD stated she would submit another work order, but AD could not provide an exact time frame or date as to when the sample sites would be remediated. (Continue to LIC 809-C)
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2023
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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 483001838
VISIT DATE: 06/23/2023
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A civil penalty of $600 is being assessed because the facility did not submit or clear its POC and for not ensuring sample sites, "A, D & G" were below the allowable level of 5.5 ppb of lead in the water, as required by Written Directives (WD), 101700.3(b)(1).

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, Justice Willis. Appeal Rights were provided.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023
LIC809 (FAS) - (06/04)
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