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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103801329
Report Date: 04/29/2022
Date Signed: 04/29/2022 03:07:53 PM


Document Has Been Signed on 04/29/2022 03:07 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, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:KINDERCARE LEARNING CENTER, #1015FACILITY NUMBER:
103801329
ADMINISTRATOR:AVALOS, TASHAFACILITY TYPE:
850
ADDRESS:1785 VILLA DRIVETELEPHONE:
(559) 297-1888
CITY:CLOVISSTATE: CAZIP CODE:
93612
CAPACITY:72CENSUS: 63DATE:
04/29/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Tasha AvalosTIME COMPLETED:
03:30 PM
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On 04/29/2022, Licensing Program Analyst (LPA) Candis Rodriguez conducted an unannounced Case Management inspection regarding an incident that occurred on 03/17/2022. LPA met with Director, explained purpose of inspection, and took a census.

On 03/17/2022, facility contacted Community Care Licensing (CCL) to report an unusual incident. Child #1 was walking along the raised cement planter surrounding a tree in the play area and tripped, hitting their forehead on the cement planter. Child #1 was picked up by Parent #1 and taken to Emergency Room and received stitches. Facility advised all staff to redirect children away from the tree and not allow walking on top of the raised cement planter, which is approximately three inches tall. Child #1 returned to the facility and injury has since healed.

LPA reviewed attendance sheets and verified there were 23 children present at the time of the incident, along with two teachers. LPA verified staff to child ratio was being followed at time of incident.

LPA interviewed Child #1. Teacher #1 and Teacher #2 were not available for interview due to no longer working at the facility. LPA obtained contact information for Teacher #1 and Teacher #2.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies cited.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Candis RodriguezTELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:
DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/29/2022
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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