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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013415774
Report Date: 08/13/2021
Date Signed: 08/13/2021 05:35:46 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
013415774
ADMINISTRATOR:WOOLSEY, SIERRAFACILITY TYPE:
840
ADDRESS:11925 AMADOR VALLEY COURTTELEPHONE:
(925) 875-0400
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY:28CENSUS: 6DATE:
08/13/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Scott KinserTIME COMPLETED:
05:15 PM
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08/13/2021, at approximately 10:30am, Licensing Program Manager Chandra Charles met with Assistant Director Scott Kinser, for a UNANNOUNCED REQUIRED RANDOM INSPECTION OF THE SCHOOL AGE COMPONENT OF THIS COMBINATION DAY-CARE CENTER.

There is one classroom that is being utilize for the School age program. Present during the inspection there were (6) school age children and (1) staff member. All children were under visual supervision. Teacher-child ratio was observed.

CLASSROOMS: The classroom was inspected. There are adequate play and learning materials available. Furniture and equipment is age appropriate and in good repair. There is adequate heating, ventilation and lighting. Drinking water is available inside the school age classroom. There are working telephones on site. There is proper individual storage space for each child. The isolation area for sick children is in the office. There is a carbon monoxide detector in the classroom, fire extinguisher and a pull down alarm device. BATHROOMS AND TOILETING AREA : There are separate bathrooms for staff and the children. Toilets and faucets working properly. Toilet paper, soap, and paper towels are all available to the children. Adequate lighting is provided in all bathrooms.

INSPECTION OF FOOD SERVICE AREA: The center provides breakfast, lunch and snacks. Food was inspected for freshness and quantity. The menus are posted for review.

INSPECTION OF OUTDOOR PLAY AREA: There are age appropriate play equipment, and materials for the school age children. There is also a shaded area. HEALTH RELATED SERVICES: Assistant Director stated there are currently no children on any medication in the School Age program. The first aid kit (backpack) is complete and available in the classroom. Sign-in and sign-out logs were reviewed to verify census and signatures. RECORDS: LPM requested and reviewed (1) Staff file and (5) children files.They were found to be incompliance with the title 22 regulations. POSTING: All required forms were posted in a public accessible area. CPR and First Aid certificates are current.

See LIC 809 C for additional information
SUPERVISOR'S NAME: Anika EvansTELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 013415774
VISIT DATE: 08/13/2021
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There are no bodies of water accessible to children. There are no firearms on the premises. Children are being visually supervised. All storage areas for poisons are locked.

This facility is not providing Incidental Medical Services-IMS at this time. LPM discussed IMS services and the requirement to update the plan of operation. Specifics on the plan can be found in the child care center evaluator manual (CCC EM) Policy 101173.

There are no deficiencies cited. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and appeal rights provided.

*** The Assistant Director advised that a decision has been to no longer have a School Age program. The Center Director is currently in conversations with the licensing application specialist about converting the school age classroom to a preschool classroom.***

SUPERVISOR'S NAME: Anika EvansTELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021
LIC809 (FAS) - (06/04)
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