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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073403053
Report Date: 06/13/2023
Date Signed: 06/13/2023 03:51:34 PM


Document Has Been Signed on 06/13/2023 03:51 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:96CENSUS: 65DATE:
06/13/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Shannon RegachoTIME COMPLETED:
04:00 PM
NARRATIVE
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On 06/13/2023 at 3:00 PM, Licensing Program Analysts (LPAs) Christina Watts and Monica Mathur conducted an unannounced Case Management inspection at Kindercare Learning Center. LPAs met with Director, Shannon Regacho and explained the purpose of this visit. Director led LPAs on a tour of the facility. During today's inspection, there were 65 preschool children in care with 9 staff. Director stated there were 92 children enrolled.

LPAs were following up on a self reported incident that occurred in the facility on June 8, 2023. The self reported incident stated that a child C1 was left alone in the play yard. During today's staff interviews S2 stated around 11:45 AM, they started to have the children line up near the door to come inside to eat lunch. S2 admitted they do not follow name to face procedure when the classroom transitioned from the play yard. S3 who is a staff in the infant room stated around 11:50 AM, she saw C1 outside alone on the play yard from her room window. Since infant room does not have direct access to yard, S3 informed S4 in the next room with direct access to the play yard that C1 was outside in the play yard. S4 stated she called C1 inside. Interviewed staff stated that C1 was not crying nor afraid. S1 and S2 stated they were not aware that C1 was left in play yard until S4 brought C1 into class. S4 stated Director was informed immediately. Staff generally agreed that C1 was left alone on the play yard without visual supervision for about 3-5 minutes. This is an absence of supervision and a zero tolerance violation under California Code of Regulations, Title 22.

LPA Christina Watts informed Director, Shannon Regacho that this report dated 06/13/2023 with 1 Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


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
VISIT DATE: 06/13/2023
NARRATIVE
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*PAGE 2*

Furthermore, LPA Watts informed the Director to provide a copy of this licensing report dated 06/13/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

LPA Christina Watts informed Director that facility has been assessed an civil penalty of $500 for absence of supervision when child was left alone on the play yard for 3-5 minutes without visual supervision.

*SEE LIC 809-D FOR DEFICIENCIES*

Exit interview conducted and report was reviewed with the Director, Shannon Regacho. A notice of site visit was given and must remain posted for 30 consecutive days.

SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 06/13/2023 03:51 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: 06/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/14/2023
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a)The licensee shall provide care and supervision...(1) No child(ren) shall be left without the supervision of a teacher at any time...Supervision shall include visual observation. This requirement has not been met as evidenced by:
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By COB 06/14/2023, Director will submit a written statement of how facility will come back into compliance.
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Based on interviews, the facility did not comply with the section cited above when C1 was left unsupersived in the play yard for about 3-5 minutes which poses an immediate risk to the health, safety or personal rights of children in care.
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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: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2023
LIC809 (FAS) - (06/04)
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