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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013415775
Report Date: 09/26/2019
Date Signed: 09/26/2019 02:55:07 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:
013415775
ADMINISTRATOR:WOOLSEY, SIERRAFACILITY TYPE:
830
ADDRESS:11925 AMADOR VALLEY COURTTELEPHONE:
(925) 875-0400
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY:36CENSUS: 26DATE:
09/26/2019
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
01:14 PM
MET WITH:Sierra WoolseyTIME COMPLETED:
03:00 PM
NARRATIVE
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1/ LPA Dayna Collier met with Center Director Sierra Woolsey for an annual required inspection. LPA toured the facility and play yard for a health and safety inspection. There were 5 staff members supervising 26 infants. A review of staff records on 9/26/19 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Personnel files were reviewed. The teacher/child ratio was being met. Children's files were reviewed. The classroom(s) and play yard were age appropriate. Changing table areas were clean and within reach of water. Bottles and cups were labelled. Each child had a daily diapering log available for review. Infant needs and services plans were being maintained. The storage of napping equipment and the arrangement of cribs were appropriate. The sign in and out logs were reviewed. All posting requirements are being met. Outdoor play area provided a shaded area for the children and access to drinking water via cups. Medications, when dispensed, are stored in the refrigerator or a locked medicine box which is inaccessible to children in care. There is a working telephone. Opening and closing staff have current CPR and first aid training.
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

The attached type B deficiency cited today and must be corrected by the due date. This report must be available for public review for 3 years. An exit interview was conducted and the report was discussed. Licensee was provided a copy of their appeal rights (LIC 9058 12/15) and the signature on this form acknowledges receipt of these rights.
A SITE VISIT NOTICE WAS POSTED BY DIRECTOR.
SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Dayna CollierTELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019
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: 013415775
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/10/2019
Section Cited

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ยง1596.7995 Employees or volunteers at day care center; immunization requirements; records; exemptions
(a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
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This requirement is not met as evidenced by record review. This poses a potential risk to children in care.
STAFF MEMBERS IDENTIFIED AS S1, S2, S3, S4 AND S5 DO NOT HAVE INFLUENZA IMMUNIZATIONS OR LETTERS OF DECLINATION IN FILE. S4 DOES NOT HAVE ALL REQUIRED IMMUN. IN FILE.
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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: Diane PerezTELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Dayna CollierTELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2019
LIC809 (FAS) - (06/04)
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