<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198003115
Report Date: 06/26/2019
Date Signed: 06/26/2019 07:23:53 PM

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:
198003115
ADMINISTRATOR:GARCIA, MELISSAFACILITY TYPE:
830
ADDRESS:1175 VIA VERDETELEPHONE:
(909) 592-2220
CITY:SAN DIMASSTATE: CAZIP CODE:
91773
CAPACITY:44CENSUS: 18DATE:
06/26/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
05:15 PM
MET WITH:Director Melissa GarciaTIME COMPLETED:
07:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
An unannounced Case managment-deficiencies inspection was conducted on this date by Licensing Program Analyst (LPA) B. Emiko Bell in order to cite for deficiencies found during an inspection. Upon arrival, LPA was greeted and let into the facility by Director Melissa Garcia, to whom the reason for the inspection was announced and who then guided LPA on a tour of the three infant rooms to take census.

In Infant A, there were 7 infants with 2 staff; in Infant B, there were 7 infants with 2 staff and there were 4 "toddlers" on the infant playground with 1 staff. Staff-child ratio was met. All are cleared and associated. (The Center does not have a Toddler component; they refer to older infants who can walk as "toddlers."

During today's inspection, the following deficiencies were discovered by LPA during file review and four Type B citations have been issued to the Center as a result:

1. During a review of the staff file, LPA observed that Staff #2 does not have verification of immunity against pertussis (DTAP shot) and measles (MMR shot). During a review of the file of Staff #3, that Staff #3 does not have verification of immunity against influenza. Verification should be obtained prior to employment. Staff #2 was hired at the end of April and Staff #3 was hired on 05/06/19.

2. During a review of the files of Staff #2 & Staff #3, LPA observed that neither have a health screening (form LIC 503) in their file. A health screening should be obtained not more than one year prior or more than seven days after employment. Staff #2 was hired at the end of April and Staff #3 was hired on 05/06/19.

3. : During a review of the files of Staff #2 & #3, LPA observed that neither have the results of a TB test in their file, though Staff #2 was hired at the end of April and Staff #3 was hired on 05/06/19. Tuberculosis clearance should be obtained not more than one year prior or more than seven days after employment.
SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019
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: 198003115
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/03/2019
Section Cited
CCR
101216(g)(3)(B)
1
2
3
4
5
6
7
Personnel Requirements
The good physical health of each volunteer who works in the center shall be verified by: Results of a test for tuberculosis performed not more than one year prior to or seven days after initial presence in the center.
-This requirement is not met as evidenced by: During a review of the files of Staff #2 & #3,
1
2
3
4
5
6
7
Director Garcia agreed to ensure that both Staff #2 & Staff #3 obtain a TB testng by the POC due date of 07/26/19. Verification of the results will be provided to CCL via e-mail, fax or mail.
8
9
10
11
12
13
14
LPA observed that neither have the results of a TB test in their file, though Staff #2 was hired at the end of April and Staff #3 was hired on 05/06/19. *This poses a potential risk to the health and safety of children in care.*
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
8
9
10
11
12
13
14
8
9
10
11
12
13
14
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: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019
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: 198003115
VISIT DATE: 06/26/2019
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
 Page 2/2

Please refer to 809D for documentation of deficiencies.

Upon receipt, Director Melissa Garcia posted the Notice of Site Visit. The Notice of Site Visit shall be posted for thirty (30) consecutive days. Failure to maintain posting as required will result in the issuance of a citation and the assessment of a $100 civil penalty.

An exit interview has been conducted with, and a copy of this report has been signed by and provided to Director Melissa Garcia. Appeal Rights have been provided and explained to Director Melissa Garcia.
SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019
LIC809 (FAS) - (06/04)
Page: 4 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: 198003115
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/08/2019
Section Cited
CCR
1596.7995.(a)(1)
1
2
3
4
5
6
7
Employees or volunteers at day care center; immunization requirements; records; exemptions
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.
1
2
3
4
5
6
7
Director Garcia agreed to ensure that Staff #2 provides verification of immunity to pertussis and measles and that Staff #3 either writes a declination or provides immunity against influenza by the POC due date of 07/08/19. Verification will be provided to CCL via e-mail, fax or mail.
8
9
10
11
12
13
14
-This requirement is not met as evidenced by: During a review of the staff file, LPA observed that Staff #2 does not have verification of immunity against pertussis (DTAP shot) and measles (MMR shot). During a review of the file of Staff #3, that Staff #3 does not have verification of immunity against influenza.
8
9
10
11
12
13
14
*This poses a potential risk to the health and safety of children in care.*
Type B
07/26/2019
Section Cited
CCR
101216(g)(1)
1
2
3
4
5
6
7
Personnel Requirements
All personnel, including the licensee, administrator and volunteers, shall be in good health and shall be physically and mentally capable of performing assigned tasks.
Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.
1
2
3
4
5
6
7
Director Garcia agreed to ensure that both Staff #2 & Staff #3 obtain a health screening by the POC due date of 07/26/19. Verification will be provided to CCL via e-mail, fax or mail.
8
9
10
11
12
13
14
-This requirement is not met as evidenced by: During a review of the files of Staff #2 & Staff #3, LPA observed that neither have a health screening (form LIC 503) in their file.
*This poses a potential risk to the health and safety of children in care.*
8
9
10
11
12
13
14
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: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4