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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493001831
Report Date: 02/01/2023
Date Signed: 02/01/2023 02:49:40 PM

Document Has Been Signed on 02/01/2023 02:49 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:
493001831
ADMINISTRATOR:PEPPER, ALEXANDRIAFACILITY TYPE:
850
ADDRESS:6150 STATE FARM DRIVETELEPHONE:
(707) 584-0124
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY: 96TOTAL ENROLLED CHILDREN: 40CENSUS: 34DATE:
02/01/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
01:36 PM
MET WITH:Alexandria "Alex" PepperTIME COMPLETED:
02:39 PM
NARRATIVE
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On 02/01/2023, Licensing Program Analyst (LPA), Y.Yang made a case management inspection and met with Director, Alex Pepper. The inspection was made in response to water lead testing results received from the California State Water Resource Control Board. The test results showed that the following faucets tested above the allowable level (5.5 ppb) of lead in the water: Sample Sites, "A" (located outside the infant room), "F" (located in the Discovery Preschool Classroom), and "M" (the drinking fountain on the playground) had a reading of 19.0ppb, 13.0ppb, and 6.0ppb, respectively. All other sources of water that were tested had a reading below the allowable level of 5.5ppb.

The facility temporarily removed the faucets from service by turning off the water supply, taping up the sink, and/or by posting a sign by the faucets. The center director notified all staff members regarding the faucet and instructed staff to not use the faucets. Children in care are receiving drinking water from individual tumblers from home and from other drinking fountains located at the center.

The Center Director 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 LPA.

The following deficiency is being cited (see LIC 809D). Appeal Rights were provided. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Center Director, Alex Pepper.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2023
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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Document Has Been Signed on 02/01/2023 02:49 PM - It Cannot Be Edited


Created By: Yang Yang On 02/01/2023 at 01:55 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: 493001831

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/01/2023
Section Cited

101700.3(b)(1)

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101700.3(b)(1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.




This requirement was not met as evidenced by:
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LPA observed that the facility has temporarily removed the affected faucets “A”, "F", and "M" from service by way of a plastic cover. The facility plans to replace the faucets and will retest and submit test results to LPA at yang.yang@dss.ca.gov by 03/01/23.
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Based on a record review, the facility had three faucets (Site “A”, "F", and "M") that exceeded the allowable levels of lead in the water. They had a reading of 19.0ppb, 13.0ppb, and 6.0ppb, respectively. This is a potential health and safety risk to children in care.
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Center Director Pepper stated children in care are receiving drinking water from other unaffected faucets at the facility. Testing results have been posted and families have been notified of the plans for remediation.

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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: 02/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2023


LIC809 (FAS) - (06/04)
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