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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073403053
Report Date: 02/09/2022
Date Signed: 03/09/2022 04:27:21 PM


Document Has Been Signed on 03/09/2022 04:27 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
073403053
ADMINISTRATOR:ADEEBA AQMALFACILITY TYPE:
850
ADDRESS:4108 LONE TREE WAYTELEPHONE:
(925) 754-1236
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:72CENSUS: 21DATE:
02/09/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:SHANNON REGACHOTIME COMPLETED:
04:45 PM
NARRATIVE
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1:45PM-LICENSING PROGRAM ANALYST ALEXANDER MET TODAY WITH CENTER DIRECTOR SHANNON REGACHO FOR A CASE MANAGEMENT VISIT TO DISCUSS AN INCIDENT THAT HAS BEEN REPORTED BY THE FACILITY ON 2/18/2022. ACCORDING TO THE REPORT, A CHILD WAS ABLE TO WALK AWAY FROM HIS/HER GROUP DURING TRANSITION FROM OUTSIDE PLAYTIME TO GO INSIDE. APPARENTLY, AFTER THE HEAD COUNT, THE CHILD WALKED AWAY UNSUPERVISED AND WAS FOUND BY OTHER STAFF MEMBERS. THE FACILITY REPORTED A SIMILAR INCIDENT INCIDENT ON 12/23/21 WHEN ANOTHER CHILD WAS ALSO ABLE WALK OUT OF HIS/HER CLASSROOM UNSUPERVISED. ON 7/26/21 THERE WAS ANOTHER LACK OF SUPERVISION INCIDENT REPORTED. IT WAS REPORTED THAT A CHILD WAS OUT OF SIGHT AND SOUND OF HIS/HER TEACHER FOR AT LEAST 15 SECONDS BEFORE ANOTHER STAFF MEMBER FOUND THE CHILD. ACCORDING TO TITLE 22 REGULATIONS, NO CHILD SHALL BE LEFT WITHOUT SUPERVISION OF A TEACHER AT ANY TIME. ALTHOUGH THE DIRECTOR HAS STATED THAT ADDITIONAL TRAINING HAS BEEN PROVIDED, THE CONTINUAL FREQUENT LACK OF SUPERVISION POSES A POTENTIAL HEALTH RISK TO CHILDREN IN CARE.

THE LIC 9224 ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS HAS BEEN GIVEN AND EXPLAINED. A COPY OF THIS REPORT IS TO BE GIVEN TO EACH DAY CARE CHILD'S PARENT/GUARDIAN BY THE NEXT BUSINESS DAY, AND THE LIC 9224 IS TO BE SIGNED AND PUT INTO THEIR CHILD'S FILE. THE FACILITY'S COPY OF THIS REPORT IS TO BE POSTED AT THE FACILITY FOR 30 DAYS, AND ANY NEWLY ENROLLED CHILD'S PARENT/GUARDIAN SHALL RECEIVE A COPY OF THIS REPORT FOR UP TO ONE YEAR.

PLEASE SEE ATTACHED 809-D FOR CITATION
AN EXIT INTERVIEW WAS CONDUCTED/NOTICE OF SITE VISIT AND APPEAL RIGHTS GIVEN
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:
DATE: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2022
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 03/09/2022 04:27 PM - It Cannot Be Edited

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, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 073403053

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/16/2022
Section Cited

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101229 Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) 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.
REQUIREMENT HAS NOT BEEN MET: ON AT LEAST 3 OCCASTIONS 3 DIFFERENT CHILDREN WERE ABLE TO WALK AWAY FROM THE CLASSROOM WITHOUT THE SUPERVISION OF THE TEACHER AND WAS FOUND BY OTHER STAFF MEMBERS.
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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: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2022
LIC809 (FAS) - (06/04)
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