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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493001830
Report Date: 12/27/2024
Date Signed: 12/27/2024 01:52:15 PM

Document Has Been Signed on 12/27/2024 01:52 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:
493001830
ADMINISTRATOR/
DIRECTOR:
RICHARDSON, KYLIEFACILITY TYPE:
830
ADDRESS:6150 STATE FARM DRIVETELEPHONE:
(707) 584-0124
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY: 40TOTAL ENROLLED CHILDREN: 33CENSUS: 16DATE:
12/27/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:19 PM
MET WITH:Alexandria "Alex" Pepper, Asst. DirectorTIME VISIT/
INSPECTION COMPLETED:
01:25 PM
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A Case Management inspection was conducted at the facility by Licensing Program Analyst (LPA) Y. Yang in response to an Unusual Incident Report (UIR) received 12/04/2024 involving a child sustaining an injury while in care. During today’s visit, the LPA met with the facility’s assistant director, Alexandria “Alex” Pepper to discuss the incident and obtain additional details. The center director, Kylie Richardson reported to the Department that on 12/03/24 at approximately 05:00pm, child C1 and another child climbed on top of a “toddler toy shelf” in the "Toddler B" classroom. Richardson reported that as staff member S1 went to assist the two children, C1 fell from the shelf and landed on the classroom’s flooring. Richardson reported that C1’s authorized representative was notified and requested that the facility contact emergency medical services. Richardson reported that C1 and their authorized representative were transported by ambulance to be examined by a medical professional and it was determined that the child had broken their collar bone because of the fall.

During today's case management visit, the LPA reviewed with the assistant director the facility's child supervision policies and made best practice recommendations to the assistant director regarding the physical plant at the facility. The LPA inspected the classroom and observed that the toddler toy shelf in the classroom is age appropriate and approximately two feet tall by four feet wide. The LPA also interviewed a staff member who was familiar with the incident. This incident was reported to CCLD and the child’s authorized representative as required per regulations.

Based on available information, it has been determined that there was no evidence of violations of regulations that occurred that lead to the child's injury. This report was read and reviewed with the assistant director, Alex Pepper. There were no Title 22 violations cited during today's case management visit. The Notice of Site Visit shall be posted for 30 days.

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE: DATE: 12/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/27/2024
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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