493001831-8-17-2023-01-CC-YYAG-CUSU8V-20230817152211

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493001831
Report Date: 08/17/2023
Date Signed: 08/17/2023 03:22:15 PM

Document Has Been Signed on 08/17/2023 03:22 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 CENTER		FACILITY NUMBER:	493001831
ADMINISTRATOR:	PEPPER, ALEXANDRIA		FACILITY TYPE:	850
ADDRESS:	6150 STATE FARM DRIVE		TELEPHONE:	(707) 584-0124
CITY:	ROHNERT PARK	STATE: CA	ZIP CODE:	94928
CAPACITY: 96	TOTAL ENROLLED CHILDREN: 96	CENSUS: 25	DATE:	08/17/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	12:58 PM
MET WITH:	Alex Pepper		TIME COMPLETED:	02:29 PM

NARRATIVE

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An unannounced case management visit was made to the facility by Licensing Program Analyst (LPA) Y. Yang in response to a self-reported, lack of supervision incident involving child C1 and C2 and staff S1 that occurred on 08/07/23. During today’s visit, the LPA met with the center director, Alex Pepper to discuss the incident.

It was reported by Center Director Pepper that on 08/07/23 at approximately 05:00pm, child C1 and C2 were left on the center's fully fenced, main playground without staff supervision as their classmates and teacher (S1) transitioned indoors. The center director reported that the two children were without supervision for approximately two minutes. The center director stated that staff S2, who was cleaning her empty classroom at the time, heard the two children crying outdoors and went to retrieve them and provided them with comfort. The center director stated that a parent observed this and notified her.

The center director reported that based on the “Child Supervision Record” (CSR) for the day, Staff S1 was supervising a total of 10 children at the time. The center director reported that as S1 opened the door to prepare children to transition inside the facility, several children ran inside and down the center’s main hallway. The center director stated that S1 then went inside the facility and shut the door behind her, leaving C1 and C2 on the playground. The center director stated that a name to face check should have been performed before the children were allowed inside the facility. The center director stated that staff are required to perform “name to face” checks at every transition and update the CSR. The center director reported that the checks were completed during the indoor to outdoor transition. The center director reported that the outdoor to indoor name to face check was performed when they returned to the classroom instead of on the playground, as required.

This self-reported incident was reported to CCLD as required per regulations. The center director reported that the authorized representatives for C1 and C2 were also notified. During today’s case management visit, no children were observed to be left without supervision.

Based on available information, it has been determined that preschool staff S1 did not provide adequate supervision to child C1 and C2 during the incident on 08/07/2023. The following violation of the California Code of Regulations, Title 22; Division 12, was observed: see LIC 809D. This is a repeat violation, and a civil penalty will be assessed. This report was read and reviewed with the center director, Alex Pepper. Notice of site visit shall be posted for 30 days. Appeal rights provided.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

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 08/17/2023 03:22 PM - It Cannot Be Edited

Created By: Yang Yang On 08/17/2023 at 01:47 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: 08/17/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/08/2023 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	Care and Supervision. No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement was not met as evidenced by: based on the center director's admission on 08/17/23 and the unusual incident report (UIR) submitted to CCLD on 08/08/23, on 08/07/23 at approximately 05:00pm, child C1 and C2 were left without supervision of a teacher for approximately two minutes while on the center's main playground before being reunited with their class.This presents a potential threat to the health and safety of children in care.	1 2 3 4 5 6 7	The center director stated that the center will be conducting a mandatory professional development day training on 09/06/23 for all staff in order to provide additional training to staff on providing care and supervision to children and completing CSR checks and transitions. The center director stated that she will submit a summary of the training along with proof of attendance to the LPA by 09/08/23.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: 08/17/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

LIC809 (FAS) - (06/04)

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