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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493001831
Report Date: 11/23/2021
Date Signed: 11/24/2021 08:55:56 AM

Document Has Been Signed on 11/24/2021 08:55 AM - 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
493001831
ADMINISTRATOR:RICHARDSON,KYLIEFACILITY TYPE:
850
ADDRESS:6150 STATE FARM DRIVETELEPHONE:
(707) 584-0124
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY: 96TOTAL ENROLLED CHILDREN: 53CENSUS: 30DATE:
11/23/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Megan Brown, Acting Center DirectorTIME COMPLETED:
04:56 PM
NARRATIVE
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An unannounced case management inspection visit was made to the facility by Licensing Program Analyst (LPA) Y.Yang to follow-up on a self-reported, unusual incident report (UIR) received by the department on 11/19/2021. During today’s inspection visit, LPA met with acting center director, Megan Brown at 02:05pm to discuss the incident.

Per the incident report submitted by the facility, on 11/16/21, it was alleged that staff S1 put their hand underneath child C1's armpit in order to lift up C1 from their chair and walk C1 to a different area of the classroom after the child declined to cooperate. Brown reported that this incident was observed by staff S2, who was also interviewed by the LPA during today's visit. Brown reported that an internal investigation into the allegation was conducted and the allegation was found to be substantiated. Brown reported that C1 did not sustain any injuries as a result of the incident but notated that this was inconsistent with KinderCare policies. Brown reported that S1 is no longer employed by the center. Brown reported that the authorized representative of C1 was notified of the incident.



Based on information obtained and the acting center director’s admission, the preponderance of evidence standard has been met; therefore, the allegation is found to be substantiated. California Code of Regulations, Title 22, is being cited on the attached LIC 809-D. Appeal rights were provided. An exit interview was conducted, and this report was read and discussed with the facility’s acting center director, Megan Brown. The Notice of Site Visit shall be posted for 30 days.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE: DATE: 11/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/23/2021
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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Document Has Been Signed on 11/24/2021 08:55 AM - It Cannot Be Edited


Created By: Yang Yang On 11/23/2021 at 02:31 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
, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 493001831

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/23/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/03/2021
Section Cited
CCR
101223(a)(3)

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Personal rights: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature. This requirement was not met as evidenced by:
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Acting center director Brown stated that she will provide a training for preschool staff regarding KinderCare policies as well as training on children's personal rights and behavior management.

The training agenda along with the attendance sheet to be submitted to CCLD by 12/03/21.
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based on a witness statement and the center's own admission, staff S1 put their hand underneath child C1's armpit in order to lift up C1 from their chair and walk C1 to a different area of the classroom after the child declined to cooperate. Per the acting center director and S2, this did not result in any injury for C1. This is a potential threat to the health and safety of 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:Alexis Hollon
LICENSING EVALUATOR NAME:Yang Yang
LICENSING EVALUATOR SIGNATURE:
DATE: 11/23/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/23/2021


LIC809 (FAS) - (06/04)
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