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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483001838
Report Date: 10/02/2024
Date Signed: 10/02/2024 04:55:26 PM

Document Has Been Signed on 10/02/2024 04:55 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:
483001838
ADMINISTRATOR/
DIRECTOR:		FIELDS, DONJEFACILITY TYPE:
850
ADDRESS:35 ROTARY WAYTELEPHONE:
(707) 557-3007
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY: 72TOTAL ENROLLED CHILDREN: 70CENSUS: 44DATE:
10/02/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:05 PM
MET WITH:Justice WillisTIME VISIT/
INSPECTION COMPLETED:
05:10 PM
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On 10/02/24 unannounced Case Management visit was made by Licensing Program Analyst (LPA), Cindy Castro, in response to Unusual Incident Report (UIR) that occurred on 09/24/24. LPA met with Center Director and Staff. The licensee self-reported the incident and submitted a UIR to the Department. Additional follow-up could be required if deemed necessary.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Cindy Castro
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2024
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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