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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198003095
Report Date: 06/29/2022
Date Signed: 06/29/2022 03:08:26 PM


Document Has Been Signed on 06/29/2022 03:08 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
198003095
ADMINISTRATOR:NATILEE CARTERFACILITY TYPE:
840
ADDRESS:455 E. FOOTHILL BOULEVARDTELEPHONE:
(909) 599-0597
CITY:SAN DIMASSTATE: CAZIP CODE:
91773
CAPACITY:49CENSUS: 27DATE:
06/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:01 PM
MET WITH:Roxanne Gonzalez (Munoz) & Lauren MierTIME COMPLETED:
03:20 PM
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Licensing Program Analysts (LPA) Jennifer Hua & Veronica Martinez-Garza conducted an unannounced Required - 1 year inspection. LPA met with director Roxanne Munoz & assistant director Lauren Mier. A COVID-19 risk assessment was conducted prior to entry to the facility. LPA provided assistant director with a copy of the LIC 125 Entrance Checklist to facilitate the inspection. This is a school-age program. Business hours are from Monday-Friday, 6:00 AM to 6:00 PM. Director Roxanne Munoz left during visit .Director came back

Director took LPAs on a facility tour at 1:03 PM. All areas identified on the Facility Sketch were inspected. There are of total of 2 classrooms for the school-age program. LPAs observed the following: The children were outside having water play. There were 27 children supervised by 2 staff.

The facility was observed to be within the license capacity and limitations. Facility roster was reviewed. . Sign-In and Sign-Out sheets were reviewed. Per assistant director, parents sign in/out on tablet with QR code App call MCT Care Connect using their individual PIN #, documents can be printed as needed.

Rooms identified on facility sketch were inspected Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Storage for children's belongings. Age appropriate sinks and toilets were inspected for availability and good repair. General sanitation was observed. Availability of indoor drinking water was observed. Snack/lunch menus reviewed and are posted.

A first aid kit is kept in each classroom. Carbon monoxide detectors and smoke detectors are present in the facility. Fire extinguishers are serviced annually. Storage cabinet in classrooms was locked and hazardous items including cleaning compounds were stored inaccessible to children.
Report continues to next page
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2022
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 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 198003095
VISIT DATE: 06/29/2022
NARRATIVE
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Outdoor equipment was inspected for safety, cushioning material, good repair and appropriateness. Required shade, drinking water and fencing were inspected. Children bring their own water bottle during this time. Play area was inspected for hazards and inaccessibility to bodies of water. No hazards observed.

Teacher--child ratios were observed and staff names recorded. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate. Personal Rights of children were observed by LPAs. Staff and children Records were reviewed for completeness. Inspection of required forms made.

Staff and Children’s Records were reviewed. Criminal Record Clearances were reviewed for Associations and Transfers. Director and Staff are current on Pediatric First aid/ CPR as observed but certificate is standard First Aid/CPR and not EMSA approved.. 3 staff does not have required Immunization. Staff have completed the Mandated Reporting training but director could not access the certificates during visit.

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 Per assistant director no medication is provided at this time.

The following was discussed with assistant director:

Rooms that are off-limits need to be made inaccessible during operating hours. Smoking is prohibited. The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and Carbon Monoxide detectors should be checked and batteries replaced as needed. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your location.

SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 198003095
VISIT DATE: 06/29/2022
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication. To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/tion-process.

For forms, updates, Title 22 Regulations visit www.ccld.ca.gov

Deficiencies cited on attached 809D

Exit interview conducted and report was reviewed with assistant director Lauren Mier. Notice of Site Visit Form provided and explained. Notice shall be posted for 30 days in a prominent area or a civil penalty of $100 will be assessed.

SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 06/29/2022 03:08 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 198003095

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in which staff #1, 2, 3 lack record which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/15/2022
Plan of Correction
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Per director will correct and submit copy to LPA by POC due date.
Type B
Section Cited
CCR
101216(f)
Personnel Requirements
(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in which staff certificate in standard not pediatric and the entity is not EMSA approved.which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/29/2022
Plan of Correction
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Per assistant director, will correct and submit copy to LPA by POC due date.

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: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 06/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4